Back pain differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Back_pain]] | |||
{{CMG}};{{AE}}{{HM}} | {{CMG}};{{AE}}{{HM}} | ||
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==Overview== | ==Overview== | ||
There are several life-threatening causes of back pain | There are several life-threatening causes of [[back]] [[pain]], including [[spinal cord]] or [[cauda equina compression]], [[aortic dissection]], [[aortic aneurysm]], vertebral [[osteomyelitis]], epidural [[abscess]], and [[metastatic cancer]]. These should be evaluated alongside other possible causes of [[back]] [[pain]] by carefully assessing the nature of the [[pain]], and obtaining a thorough [[patient]] history. | ||
==Differential Diagnosis== | ==Differential Diagnosis of Back Pain== | ||
'''The following table outlines the major differential diagnoses of back pain.''' | |||
'''''To review the differential diagnosis of back pain and bowel or bladder dysfunction, [[Back pain and bowel or bladder dysfunction|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain, bowel or bladder dysfunction and horner's syndrome, [[Back pain, bowel or bladder dysfunction and horner's syndrome|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and fever, [[Back pain and fever|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain, fever and stiffness, [[Back pain, fever and stiffness|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and heart murmur, [[Back pain and heart murmur|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and headache, [[Back pain and headache|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and horner's syndrome, [[Back pain and horner's syndrome|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and motor weakness, [[Back pain and motor weakness|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain, motor weakness and sensory deficit, [[Back pain, motor weakness and sensory deficit|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and nausea and vomiting, [[Back pain and nausea and vomiting|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and pulse deficit, [[Back pain and pulse deficit|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain and sensory deficit, [[Back pain and sensory deficit|click here]]'''.'' | |||
''' | '''''To review the differential diagnosis of back pain and stiffness, [[Back pain and stiffness|click here]]'''.'' | ||
''' | '''''To review the differential diagnosis of back pain and syncopy, [[Back pain and syncopy|click here]]'''.'' | ||
'''''To review the differential diagnosis of back pain and weight loss, [[Back pain and weight loss|click here]]'''.'' | |||
'''''To review the differential diagnosis of back pain exhibiting "red flags", [[Back pain red flags|click here]]'''.'' | |||
'''Abbreviations:''' [[ABG]] = [[Arterial blood gases]], [[ANA]] = [[Antinuclear antibodies]], [[BUN]] = [[Blood urea nitrogen]], [[CRP]] = C-reactive protein, CT = [[Computed tomography]], DRA = Dual energy radiographic absorptiometry, DRE = [[Digital rectal exam]], [[ERCP]] = [[Endoscopic retrograde cholangiopancreatography]], [[ESR]] = [[Erythrocyte sedimentation rate]], HSV = [[Herpes simplex virus]], IVP = [[Intravenous pyelography]], KUB = Kidney, bladder, ureter, LDH = [[Lactate dehydrogenase]], LFT = [[Liver function test]], MRA = [[Magnetic resonance angiography]], MRC = [[Magnetic resonance cholangiopancreatography]], [[MRI]] = [[Magnetic resonance imaging]], MRU = Magnetic resonance urography, [[NSAID]]s = Non-steroidal anti-inflammatory drugs, PCR = [[Polymerase chain reaction]], [[PET]] - FDG = Positive emission tomography - fluorodeoxyglucose, [[PET]] = Positive emission tomography, PID = [[Pelvic inflammatory disease]], PSA = Prostatic specific antigen, PTC = [[Percutaneous transhepatic cholangiography]], [[RUQ]] = [[Right upper quadrant]], SPECT = Single-photon emission computed tomography, TFT = [[Thyroid function test]], VZV = [[Varicella zoster virus]] | |||
<small><small> | <small><small> | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
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! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Vascular | ! rowspan="1" align="center" style="background:#4479BA; color: #FFFFFF;" |Vascular | ||
![[Retroperitoneal hematoma]]<ref name="pmid25744173">{{cite journal |vauthors=Poplin GS, McMurry TL, Forman JL, Hartka T, Park G, Shaw G, Shin J, Kim Hj, Crandall J |title=Nature and etiology of hollow-organ abdominal injuries in frontal crashes |journal=Accid Anal Prev |volume=78 |issue= |pages=51–7 |date=May 2015 |pmid=25744173 |doi=10.1016/j.aap.2015.02.015 |url=}}</ref><ref name="pmid16508495">{{cite journal |vauthors=Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H |title=American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries |journal=J Trauma |volume=60 |issue=2 |pages=351–6 |date=February 2006 |pmid=16508495 |doi=10.1097/01.ta.0000202509.32188.72 |url=}}</ref><ref name="pmid23790766">{{cite journal |vauthors=Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS |title=Patterns and management of blunt abdominal aortic injury |journal=Ann Vasc Surg |volume=27 |issue=8 |pages=1074–80 |date=November 2013 |pmid=23790766 |doi=10.1016/j.avsg.2012.09.019 |url=}}</ref> | ![[Retroperitoneal hematoma]]<ref name="pmid25744173">{{cite journal |vauthors=Poplin GS, McMurry TL, Forman JL, Hartka T, Park G, Shaw G, Shin J, Kim Hj, Crandall J |title=Nature and etiology of hollow-organ abdominal injuries in frontal crashes |journal=Accid Anal Prev |volume=78 |issue= |pages=51–7 |date=May 2015 |pmid=25744173 |doi=10.1016/j.aap.2015.02.015 |url=}}</ref><ref name="pmid16508495">{{cite journal |vauthors=Kuan JK, Wright JL, Nathens AB, Rivara FP, Wessells H |title=American Association for the Surgery of Trauma Organ Injury Scale for kidney injuries predicts nephrectomy, dialysis, and death in patients with blunt injury and nephrectomy for penetrating injuries |journal=J Trauma |volume=60 |issue=2 |pages=351–6 |date=February 2006 |pmid=16508495 |doi=10.1097/01.ta.0000202509.32188.72 |url=}}</ref><ref name="pmid23790766">{{cite journal |vauthors=Harris DG, Drucker CB, Brenner ML, Sarkar R, Narayan M, Crawford RS |title=Patterns and management of blunt abdominal aortic injury |journal=Ann Vasc Surg |volume=27 |issue=8 |pages=1074–80 |date=November 2013 |pmid=23790766 |doi=10.1016/j.avsg.2012.09.019 |url=}}</ref> | ||
|Acute or subacute | |[[Acute]] or [[subacute]] | ||
|Minutes to hours | |Minutes to hours | ||
|Sharp and knife-like, also tearing or ripping | |Sharp and knife-like, also tearing or ripping | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
Typically no specific lab findings, however, evidence of | Typically no specific lab findings, however, evidence of [[hemorrhage]] and organ injury may be seen in: | ||
* Complete blood count; normochromic normocytic anemia seen in | |||
* Elevated serum electrolytes | *[[Complete blood count]]; [[normochromic normocytic anemia]] seen in [[hemorrhage]] | ||
* Elevated liver function tests | *Elevated serum [[electrolytes]] | ||
* Elevated amylase or lipase | *Elevated [[liver function tests]] | ||
|CT with IV contrast | *Elevated [[amylase]] or [[lipase]] | ||
* May show venous delay and indicate renal trauma | |[[CT]] with IV contrast | ||
Cystography | |||
* Should be considered in evaluation of hematuria and pelvic injury | *May show venous delay and indicate renal trauma | ||
[[Cystography]] | |||
*Should be considered in evaluation of [[hematuria]] and pelvic injury | |||
| | | | ||
* Mostly caused by automobile accidents | *Mostly caused by automobile accidents | ||
|- | |- | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
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|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|CSF | |CSF | ||
* Elevated protein with normal or low glucose | |||
*Elevated protein with normal or low [[glucose]] | |||
Culture and sensitivity | Culture and sensitivity | ||
* May be due to TB or Meningitis | |||
*May be due to [[TB]] or [[Meningitis]] | |||
Nucleic acid tests | Nucleic acid tests | ||
* Helpful in tuberculous meningitis | |||
*Helpful in tuberculous [[meningitis]] | |||
|Radiography | |Radiography | ||
* Thickened nerve roots | |||
CT | *Thickened nerve roots | ||
* Narrowing of subarachnoid space | |||
* Irregular collections of contrast material | [[CT]] | ||
* Thickened nerve roots | |||
MRI | *Narrowing of subarachnoid space | ||
* Study of choice shows indistinct cord outline | *Irregular collections of contrast material | ||
*Thickened nerve roots | |||
[[MRI]] | |||
*Study of choice shows indistinct cord outline | |||
| | | | ||
* Usually caused by meningitis or TB | *Usually caused by [[meningitis]] or [[TB]] | ||
|- | |- | ||
![[Cauda equina syndrome]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref> | ![[Cauda equina syndrome]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref> | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
EMG | *To rule out [[anemia]] | ||
* Done to rule out acute denervation | |||
[[Electrolytes]], [[blood urea nitrogen]], and [[creatinine]] | |||
*To rule out [[renal failure]] and [[retroperitoneal hematoma]] | |||
[[Erythrocyte sedimentation rate]] | |||
*To rule out inflammatory origin | |||
[[Syphilis]] serology | |||
*To rule out meningovascular syphilis | |||
|Radiography | |||
*May show vertebral erosions | |||
MRI | |||
*Of choice and may show nerve root abnormalities | |||
Duplex | |||
*For vascular abnormalities | |||
[[Lumbar puncture]] | |||
*For inflammation | |||
|Electrical studies: | |||
[[EMG]] | |||
*Done to rule out acute denervation | |||
SSEPs | SSEPs | ||
* Done to rule out multiple sclerosis | |||
*Done to rule out [[multiple sclerosis]] | |||
|- | |- | ||
![[Epidural abscess]]<ref name="pmid10201299">{{cite journal |vauthors=Nathoo N, Nadvi SS, van Dellen JR |title=Cranial extradural empyema in the era of computed tomography: a review of 82 cases |journal=Neurosurgery |volume=44 |issue=4 |pages=748–53; discussion 753–4 |date=April 1999 |pmid=10201299 |doi= |url=}}</ref><ref name="pmid14519222">{{cite journal |vauthors=Heran NS, Steinbok P, Cochrane DD |title=Conservative neurosurgical management of intracranial epidural abscesses in children |journal=Neurosurgery |volume=53 |issue=4 |pages=893–7; discussion 897–8 |date=October 2003 |pmid=14519222 |doi= |url=}}</ref> | ![[Epidural abscess]]<ref name="pmid10201299">{{cite journal |vauthors=Nathoo N, Nadvi SS, van Dellen JR |title=Cranial extradural empyema in the era of computed tomography: a review of 82 cases |journal=Neurosurgery |volume=44 |issue=4 |pages=748–53; discussion 753–4 |date=April 1999 |pmid=10201299 |doi= |url=}}</ref><ref name="pmid14519222">{{cite journal |vauthors=Heran NS, Steinbok P, Cochrane DD |title=Conservative neurosurgical management of intracranial epidural abscesses in children |journal=Neurosurgery |volume=53 |issue=4 |pages=893–7; discussion 897–8 |date=October 2003 |pmid=14519222 |doi= |url=}}</ref> | ||
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|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|CBC | |[[CBC]] | ||
* May | *May show [[leukocytosis]], left shift, [[thrombocytopenia]], and [[anemia]] | ||
ESR | ESR | ||
* Elevated | |||
*Elevated | |||
Culture and sensitivity | Culture and sensitivity | ||
* To identify causative organism | |||
*To identify causative organism | |||
Immunohistochemical staining | Immunohistochemical staining | ||
* Includes gram stain, special stains for fungi and mycobacteria, also consider brucella | |||
*Includes [[gram stain]], special stains for [[fungi]] and [[mycobacteria]], also consider [[brucella]] | |||
|MRI | |MRI | ||
* Of choice and demonstrates fluid collection | |||
*Of choice and demonstrates fluid collection | |||
CT | CT | ||
* Demonstrates fluid collection | |||
*Demonstrates fluid collection | |||
Radiography | Radiography | ||
* Demonstrates osteomyelitis or vertebral collapse | |||
*Demonstrates [[osteomyelitis]] or vertebral collapse | |||
| | | | ||
* LP carries risk of spread of infection | *LP carries risk of spread of infection | ||
|- | |- | ||
![[Radiculopathy]]<ref name="pmid8219542">{{cite journal |vauthors=Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS |title=A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis |journal=J Spinal Disord |volume=6 |issue=4 |pages=289–95 |date=August 1993 |pmid=8219542 |doi= |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Tarulli AW, Raynor EM |title=Lumbosacral radiculopathy |journal=Neurol Clin |volume=25 |issue=2 |pages=387–405 |date=May 2007 |pmid= |doi=10.1016/j.ncl.2007.01.008 |url=}}</ref> | ![[Radiculopathy]]<ref name="pmid8219542">{{cite journal |vauthors=Bischoff RJ, Rodriguez RP, Gupta K, Righi A, Dalton JE, Whitecloud TS |title=A comparison of computed tomography-myelography, magnetic resonance imaging, and myelography in the diagnosis of herniated nucleus pulposus and spinal stenosis |journal=J Spinal Disord |volume=6 |issue=4 |pages=289–95 |date=August 1993 |pmid=8219542 |doi= |url=}}</ref><ref name="pmid">{{cite journal |vauthors=Tarulli AW, Raynor EM |title=Lumbosacral radiculopathy |journal=Neurol Clin |volume=25 |issue=2 |pages=387–405 |date=May 2007 |pmid= |doi=10.1016/j.ncl.2007.01.008 |url=}}</ref> | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
* Typically no specific lab findings | *Typically no specific lab findings | ||
| | | | ||
Radiography | Radiography | ||
* To rule out serious underlying etiology | |||
*To rule out serious underlying etiology | |||
CT | CT | ||
* Demonstrates disc herniation | |||
*Demonstrates [[disc herniation]] | |||
MRI | MRI | ||
* Demonstrates disc herniation and nerve root impingement | |||
*Demonstrates [[disc herniation]] and nerve root impingement | |||
Myelography | Myelography | ||
* Used preoperatively to visualize spinal anatomy accurately | |||
*Used preoperatively to visualize spinal anatomy accurately | |||
Discography | Discography | ||
* To localize a symptomatic disc | |||
*To localize a symptomatic disc | |||
| | | | ||
*Disc herniation is the most common cause of nerve impingement | *[[Disc herniation]] is the most common cause of nerve impingement | ||
|- | |- | ||
![[Sciatica]]<ref name="pmid967084">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref> | ![[Sciatica]]<ref name="pmid967084">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref><ref name="pmid9971865">{{cite journal |vauthors=Vroomen PC, de Krom MC, Wilmink JT, Kester AD, Knottnerus JA |title=Lack of effectiveness of bed rest for sciatica |journal=N. Engl. J. Med. |volume=340 |issue=6 |pages=418–23 |date=February 1999 |pmid=9971865 |doi=10.1056/NEJM199902113400602 |url=}}</ref> | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|To exclude other pathologies | |To exclude other pathologies | ||
* CBC with differential | |||
* ESR | *[[CBC]] with differential | ||
* Alkaline and acid phosphatase level | *[[ESR]] | ||
* Serum calcium level | *Alkaline and acid phosphatase level | ||
* Serum protein electrophoresis | *Serum [[calcium]] level | ||
*Serum [[protein]] electrophoresis | |||
| | | | ||
Radiography | Radiography | ||
* With technetium-99m labeled phosphorus to indicate bone mineralization status | |||
*With technetium-99m labeled [[phosphorus]] to indicate bone mineralization status | |||
CT | CT | ||
* Demonstrates disc herniation | |||
*Demonstrates [[disc herniation]] | |||
MRI | MRI | ||
* Demonstrates disc herniation and nerve root impingement | |||
*Demonstrates [[disc herniation]] and nerve root impingement | |||
Myelography | Myelography | ||
* Used preoperatively to visualize spinal anatomy accurately | |||
*Used preoperatively to visualize spinal anatomy accurately | |||
Discography | Discography | ||
* To localize a symptomatic disc | |||
*To localize a symptomatic disc | |||
| | | | ||
*May have a psychological component | *May have a psychological component | ||
|- | |- | ||
![[Spinal cord compression]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref> | ![[Spinal cord compression]]<ref name="pmid2096606">{{cite journal |vauthors=Bach F, Larsen BH, Rohde K, Børgesen SE, Gjerris F, Bøge-Rasmussen T, Agerlin N, Rasmusson B, Stjernholm P, Sørensen PS |title=Metastatic spinal cord compression. Occurrence, symptoms, clinical presentations and prognosis in 398 patients with spinal cord compression |journal=Acta Neurochir (Wien) |volume=107 |issue=1-2 |pages=37–43 |date=1990 |pmid=2096606 |doi= |url=}}</ref><ref name="pmid8204366">{{cite journal |vauthors=Helweg-Larsen S, Sørensen PS |title=Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients |journal=Eur. J. Cancer |volume=30A |issue=3 |pages=396–8 |date=1994 |pmid=8204366 |doi= |url=}}</ref> | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Neoplasm must be suspected and is ruled out by | |Neoplasm must be suspected and is ruled out by | ||
** CBC - May demonstrate a pancytopenia | |||
** Prothrombin time and activated partial thromboplastin time - May be prolonged | **CBC - May demonstrate a [[pancytopenia]] | ||
** Metabolic profile, including calcium level and liver function - May indicate metastasis | **[[Prothrombin time]] and activated [[partial thromboplastin time]] - May be prolonged | ||
**Metabolic profile, including calcium level and liver function - May indicate [[metastasis]] | |||
|MRI | |MRI | ||
* May demonstrate tumors and collapse of intervertebral spaces | |||
* May distinguish between bone lesions and malignancy | *May demonstrate tumors and collapse of intervertebral spaces | ||
*May distinguish between bone lesions and malignancy | |||
Radiography | Radiography | ||
* May demonstrates bony destruction or calcification | |||
*May demonstrates bony destruction or [[calcification]] | |||
Nuclear imaging | Nuclear imaging | ||
* To identify neoplasms | |||
*To identify neoplasms | |||
| | | | ||
*Aggressive radiotherapy is often needed | *Aggressive radiotherapy is often needed | ||
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! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
* Typically no specific lab findings | *Typically no specific lab findings | ||
|MRI | |MRI | ||
* Demonstrates both inflammatory and structural lesions | |||
*Demonstrates both inflammatory and structural lesions | |||
CT | CT | ||
* Useful in identifying structural lesions | |||
*Useful in identifying structural lesions | |||
Radiography | Radiography | ||
* Useful in identifying structural lesions | |||
*Useful in identifying structural lesions | |||
Doppler ultrasound | Doppler ultrasound | ||
* To detect active esthesitis | |||
*To detect active esthesitis | |||
| | | | ||
Extra-articular manifestations are common and include | Extra-articular manifestations are common and include | ||
* Uveitis | |||
* CVD | *[[Uveitis]] | ||
* | *CVD | ||
* Renal disease | *Respiratory disease | ||
* Neurologic disease | *Renal disease | ||
* GI disease | *Neurologic disease | ||
* Metabolic bone disease | *GI disease | ||
*Metabolic bone disease | |||
Often affecting a young male | Often affecting a young male | ||
|- | |- | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
* Typically no specific lab findings | *Typically no specific lab findings | ||
| | | | ||
MRI | MRI | ||
* Of choice and demonstrates transitional vertebra | |||
*Of choice and demonstrates transitional vertebra | |||
CT | CT | ||
* Demonstrates vertebral transition | |||
*Demonstrates vertebral transition | |||
Radiography | Radiography | ||
* Demonstrates vertebral transition | |||
*Demonstrates vertebral transition | |||
| | | | ||
* Congenital anomaly and may be asymptomatic | *Congenital anomaly and may be asymptomatic | ||
|- | |- | ||
![[Osteomyelitis|Chronic recurrent focal osteomyelitis]]<ref name="pmid15276398">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=Lancet |volume=364 |issue=9431 |pages=369–79 |date=2004 |pmid=15276398 |doi=10.1016/S0140-6736(04)16727-5 |url=}}</ref><ref name="pmid9431368">{{cite journal |vauthors=Mader JT, Shirtliff M, Calhoun JH |title=Staging and staging application in osteomyelitis |journal=Clin. Infect. Dis. |volume=25 |issue=6 |pages=1303–9 |date=December 1997 |pmid=9431368 |doi= |url=}}</ref><ref name="pmid9077380">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=N. Engl. J. Med. |volume=336 |issue=14 |pages=999–1007 |date=April 1997 |pmid=9077380 |doi=10.1056/NEJM199704033361406 |url=}}</ref> | ![[Osteomyelitis|Chronic recurrent focal osteomyelitis]]<ref name="pmid15276398">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=Lancet |volume=364 |issue=9431 |pages=369–79 |date=2004 |pmid=15276398 |doi=10.1016/S0140-6736(04)16727-5 |url=}}</ref><ref name="pmid9431368">{{cite journal |vauthors=Mader JT, Shirtliff M, Calhoun JH |title=Staging and staging application in osteomyelitis |journal=Clin. Infect. Dis. |volume=25 |issue=6 |pages=1303–9 |date=December 1997 |pmid=9431368 |doi= |url=}}</ref><ref name="pmid9077380">{{cite journal |vauthors=Lew DP, Waldvogel FA |title=Osteomyelitis |journal=N. Engl. J. Med. |volume=336 |issue=14 |pages=999–1007 |date=April 1997 |pmid=9077380 |doi=10.1056/NEJM199704033361406 |url=}}</ref> | ||
Line 479: | Line 559: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |[[CBC]] | ||
* Leukocytosis and left shift | *[[Leukocytosis]] and left shift | ||
ESR | |||
* Elevated | [[ESR]] | ||
CRP | |||
* Elevated | *Elevated | ||
Procalcitonin | |||
* Elevated | [[CRP]] | ||
*Elevated | |||
[[Procalcitonin]] | |||
*Elevated | |||
Culture and sensitivity | Culture and sensitivity | ||
* To identify causative agent | |||
*To identify causative agent | |||
|Radiography | |Radiography | ||
* Demonstrates endosteal or medullary lesion | |||
* Sequestration and cavity formation | *Demonstrates endosteal or medullary lesion | ||
*Sequestration and cavity formation | |||
MRI | MRI | ||
* Bone marrow abnormalities and lytic changes | |||
*[[Bone marrow]] abnormalities and lytic changes | |||
CT | CT | ||
* Articular and periarticular involvement | |||
*Articular and periarticular involvement | |||
Ultrasound | Ultrasound | ||
* Soft tissue abnormalities | |||
*Soft tissue abnormalities | |||
Nuclear imaging | Nuclear imaging | ||
* Loss of bone density | |||
*Loss of [[bone density]] | |||
| | | | ||
*Acute presentation is often seen in children and is associated with gait abnormalities | *Acute presentation is often seen in children and is associated with gait abnormalities | ||
Line 525: | Line 622: | ||
|Radiography | |Radiography | ||
*May demonstrate fracture of the vertebrae and/or preexisting pathology that may have lead to fracture | |||
*May demonstrate [[fracture]] of the vertebrae and/or preexisting pathology that may have lead to [[fracture]] | |||
CT | CT | ||
*May show pathology that was not noted on radiography | *May show pathology that was not noted on radiography | ||
MRI | MRI | ||
*May show pathology that was not noted on radiography | *May show pathology that was not noted on radiography | ||
| | | | ||
Line 552: | Line 654: | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|Serology | |Serology | ||
*HLA-B27 may be positive or negative | |||
*IgA may be elevated | *[[HLA-B27]] may be positive or negative | ||
*ANA may be positive | *[[IgA]] may be elevated | ||
*Rheumatoid factor may be positive | *[[ANA]] may be positive | ||
CBC | *[[Rheumatoid factor]] may be positive | ||
*May indicate anemia | |||
ESR | [[CBC]] | ||
*May indicate [[anemia]] | |||
[[ESR]] | |||
*May be elevated | *May be elevated | ||
CRP | |||
[[CRP]] | |||
*May be elevated | *May be elevated | ||
Uric acid | |||
[[Uric acid]] | |||
*May be elevated | *May be elevated | ||
|MRI | |MRI | ||
*Demonstrates delineation and position of vertebrae | *Demonstrates delineation and position of vertebrae | ||
CT | CT | ||
*Demonstrates delineation and position of vertebrae | *Demonstrates delineation and position of vertebrae | ||
*May also visualize nerve root compression and nerve swelling | *May also visualize nerve root compression and nerve swelling | ||
Diskography | Diskography | ||
*Controversial, demonstrates disc herniation | |||
*Controversial, demonstrates [[disc herniation]] | |||
| | | | ||
*Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with radicular pain | *Transforaminal selective nerve root blocks are used diagnostically and therapeutically in cases presenting with [[radicular pain]] | ||
|- | |- | ||
![[Spinal disc herniation|Disc herniation]]<ref name="pmid9670842">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid12152441">{{cite journal |vauthors=Levin KH |title=Electrodiagnostic approach to the patient with suspected radiculopathy |journal=Neurol Clin |volume=20 |issue=2 |pages=397–421, vi |date=May 2002 |pmid=12152441 |doi= |url=}}</ref> | ![[Spinal disc herniation|Disc herniation]]<ref name="pmid9670842">{{cite journal |vauthors=Hay MC |title=Anatomy of the lumbar spine |journal=Med. J. Aust. |volume=1 |issue=23 |pages=874–6 |date=June 1976 |pmid=967084 |doi= |url=}}</ref><ref name="pmid12152441">{{cite journal |vauthors=Levin KH |title=Electrodiagnostic approach to the patient with suspected radiculopathy |journal=Neurol Clin |volume=20 |issue=2 |pages=397–421, vi |date=May 2002 |pmid=12152441 |doi= |url=}}</ref> | ||
Line 595: | Line 711: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
|MRI | |MRI | ||
*Demonstrates the size and location of the herniated disc and surrounding soft tissue | *Demonstrates the size and location of the herniated disc and surrounding soft tissue | ||
CT myelography | CT myelography | ||
*Useful in lateral herniations with calcification | |||
*Useful in lateral herniations with [[calcification]] | |||
Radiography | Radiography | ||
*Demonstrates osteophytes, disc-space narrowing, and kyphosis | |||
*Demonstrates osteophytes, disc-space narrowing, and [[kyphosis]] | |||
Discography | Discography | ||
*Controversial, may show endplate irregularites or annular tears | *Controversial, may show endplate irregularites or annular tears | ||
| | | | ||
Line 623: | Line 746: | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |[[CBC]] | ||
*May demonstrate leukocytosis | *May demonstrate [[leukocytosis]] | ||
ESR | |||
[[ESR]] | |||
*May be elevated | *May be elevated | ||
CRP | |||
[[CRP]] | |||
*May be elevated | *May be elevated | ||
Procalcitonin | |||
[[Procalcitonin]] | |||
*May be elevated | *May be elevated | ||
Culture and sensitivity | Culture and sensitivity | ||
*To identify causative agent | *To identify causative agent | ||
|MRI | |[[MRI]] | ||
*Narrowing of disk space and low signalling indicates edema | *Narrowing of disk space and low signalling indicates [[edema]] | ||
CT | |||
*Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus | [[CT]] | ||
*Detects lesions earlier than radiography, demonstrates hypodensity of disk and destruction of endplates and calcification of annulus | |||
Radiography | Radiography | ||
*Disk space narrowing with destruction of endplates and | |||
*Disk space narrowing with destruction of endplates and c[[alcification]] of annulus | |||
Nuclear imaging | Nuclear imaging | ||
*Focal uptake of gallium-67 and technetium-99m in area of destruction | *Focal uptake of gallium-67 and technetium-99m in area of destruction | ||
| | | | ||
Line 665: | Line 802: | ||
*Typically no specific lab findings, however; CBC may be done to rule out other serious pathologies. | *Typically no specific lab findings, however; CBC may be done to rule out other serious pathologies. | ||
|Radiography | |Radiography | ||
*Wedge-shaped vertebrae | *Wedge-shaped vertebrae | ||
*Narrow intervertebral disk spaces with calcifications | *Narrow intervertebral disk spaces with calcifications | ||
*Prominent irregularities of vertebrae | *Prominent irregularities of vertebrae | ||
*Arcuate kyphosis | *Arcuate [[kyphosis]] | ||
| | | | ||
*Often begins as loss of height with normal aging | *Often begins as loss of height with normal [[aging]] | ||
|- | |- | ||
![[Osteoarthritis]]<ref name="pmid18296075">{{cite journal |vauthors=Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R |title=Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative |journal=Osteoarthr. Cartil. |volume=16 |issue=4 |pages=415–22 |date=April 2008 |pmid=18296075 |doi=10.1016/j.joca.2007.12.017 |url=}}</ref><ref name="pmid9462165">{{cite journal |vauthors=Hurley MV, Scott DL, Rees J, Newham DJ |title=Sensorimotor changes and functional performance in patients with knee osteoarthritis |journal=Ann. Rheum. Dis. |volume=56 |issue=11 |pages=641–8 |date=November 1997 |pmid=9462165 |pmc=1752287 |doi= |url=}}</ref><ref name="pmid18203312">{{cite journal |vauthors=Sale JE, Gignac M, Hawker G |title=The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis |journal=J. Rheumatol. |volume=35 |issue=2 |pages=335–42 |date=February 2008 |pmid=18203312 |doi= |url=}}</ref> | ![[Osteoarthritis]]<ref name="pmid18296075">{{cite journal |vauthors=Hawker GA, Stewart L, French MR, Cibere J, Jordan JM, March L, Suarez-Almazor M, Gooberman-Hill R |title=Understanding the pain experience in hip and knee osteoarthritis--an OARSI/OMERACT initiative |journal=Osteoarthr. Cartil. |volume=16 |issue=4 |pages=415–22 |date=April 2008 |pmid=18296075 |doi=10.1016/j.joca.2007.12.017 |url=}}</ref><ref name="pmid9462165">{{cite journal |vauthors=Hurley MV, Scott DL, Rees J, Newham DJ |title=Sensorimotor changes and functional performance in patients with knee osteoarthritis |journal=Ann. Rheum. Dis. |volume=56 |issue=11 |pages=641–8 |date=November 1997 |pmid=9462165 |pmc=1752287 |doi= |url=}}</ref><ref name="pmid18203312">{{cite journal |vauthors=Sale JE, Gignac M, Hawker G |title=The relationship between disease symptoms, life events, coping and treatment, and depression among older adults with osteoarthritis |journal=J. Rheumatol. |volume=35 |issue=2 |pages=335–42 |date=February 2008 |pmid=18203312 |doi= |url=}}</ref> | ||
|Chronic | |Chronic | ||
|Years | |Years | ||
|Dull aching | |Dull aching | ||
Line 691: | Line 829: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|ESR | |ESR | ||
* Elevated | |||
*Elevated | |||
CRP | CRP | ||
* Elevated | |||
*Elevated | |||
Synovial fluid analysis | Synovial fluid analysis | ||
* WBCs < 2000/mm3 | |||
* Polys < 25% | *WBCs < 2000/mm3 | ||
* Culture negative | *Polys < 25% | ||
* Crystal negative | *Culture negative | ||
* Elevated IL-2, IL-5, MCP-1 | *Crystal negative | ||
*Elevated IL-2, IL-5, MCP-1 | |||
|Radiography | |Radiography | ||
* Asymmetric joint space narrowing | |||
* Subchondral sclerosis | *Asymmetric joint space narrowing | ||
* Subchondral cysts | *Subchondral sclerosis | ||
*Subchondral cysts | |||
MRI | MRI | ||
* Joint space narrowing | |||
* Degeneration | *Joint space narrowing | ||
*Degeneration | |||
| | | | ||
* Gradual onset | *Gradual onset | ||
* Polyarthritis | *Polyarthritis | ||
* Hips, knees, distal and proximal interphalyngeal joints and spine involvement | *Hips, knees, distal and proximal interphalyngeal joints and spine involvement | ||
* Bouchard's and Heberden's | *Bouchard's and Heberden's nodes | ||
|- | |- | ||
!Sacroiliac joint dysfunction<ref name="pmid23409086">{{cite journal |vauthors=Betti L, von Cramon-Taubadel N, Manica A, Lycett SJ |title=Global geometric morphometric analyses of the human pelvis reveal substantial neutral population history effects, even across sexes |journal=PLoS ONE |volume=8 |issue=2 |pages=e55909 |date=2013 |pmid=23409086 |pmc=3567032 |doi=10.1371/journal.pone.0055909 |url=}}</ref><ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref> | !Sacroiliac joint dysfunction<ref name="pmid23409086">{{cite journal |vauthors=Betti L, von Cramon-Taubadel N, Manica A, Lycett SJ |title=Global geometric morphometric analyses of the human pelvis reveal substantial neutral population history effects, even across sexes |journal=PLoS ONE |volume=8 |issue=2 |pages=e55909 |date=2013 |pmid=23409086 |pmc=3567032 |doi=10.1371/journal.pone.0055909 |url=}}</ref><ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref> | ||
Line 732: | Line 878: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*May show leukocytosis | |||
*May show [[leukocytosis]] | |||
ESR | ESR | ||
*May be elevated | *May be elevated | ||
CRP | CRP | ||
*May be elevated | *May be elevated | ||
Serology | Serology | ||
*ANA | |||
*Rheumatoid factor | *[[ANA]] | ||
*HLA-B27 | *[[Rheumatoid factor]] | ||
*[[HLA-B27]] | |||
Metabolic panel | Metabolic panel | ||
*May indicate hypothyroidism or cortisol abnormalities | *May indicate hypothyroidism or cortisol abnormalities | ||
|Imaging is controversial, however, CT may demonstrate; | |Imaging is controversial, however, CT may demonstrate; | ||
*Reactive spurs | *Reactive spurs | ||
*Sclerosis | *Sclerosis | ||
*Subluxation | *Subluxation | ||
MRI | MRI | ||
*Used primarily to exclude disc herniation | |||
*Used primarily to exclude [[disc herniation]] | |||
Nuclear imaging | Nuclear imaging | ||
*Used to rule out stress fractures and metastatic bone disease | *Used to rule out stress fractures and metastatic bone disease | ||
| | | | ||
*Rehabilitation is often sought | *[[Rehabilitation]] is often sought | ||
|- | |- | ||
!Sacroilitis<ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref><ref name="pmid6600615">{{cite journal |vauthors=Carette S, Graham D, Little H, Rubenstein J, Rosen P |title=The natural disease course of ankylosing spondylitis |journal=Arthritis Rheum. |volume=26 |issue=2 |pages=186–90 |date=February 1983 |pmid=6600615 |doi= |url=}}</ref> | !Sacroilitis<ref name="pmid17117004">{{cite journal |vauthors=Foley BS, Buschbacher RM |title=Sacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment |journal=Am J Phys Med Rehabil |volume=85 |issue=12 |pages=997–1006 |date=December 2006 |pmid=17117004 |doi=10.1097/01.phm.0000247633.68694.c1 |url=}}</ref><ref name="pmid6600615">{{cite journal |vauthors=Carette S, Graham D, Little H, Rubenstein J, Rosen P |title=The natural disease course of ankylosing spondylitis |journal=Arthritis Rheum. |volume=26 |issue=2 |pages=186–90 |date=February 1983 |pmid=6600615 |doi= |url=}}</ref> | ||
Line 773: | Line 933: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*May demonstrate leukocytosis | |||
*May demonstrate [[leukocytosis]] | |||
ESR | ESR | ||
*May be elevated | *May be elevated | ||
CRP | CRP | ||
*May be elevated | *May be elevated | ||
Procalcitonin | Procalcitonin | ||
*May be elevated | *May be elevated | ||
Culture and sensitivity | Culture and sensitivity | ||
*To identify causative agent | *To identify causative agent | ||
|MRI | |MRI | ||
*Narrowing of joint space and low signalling indicates edema | |||
*Narrowing of joint space and low signalling indicates edema | |||
CT | CT | ||
*Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface | |||
*Detects lesions earlier than radiography, demonstrates hypodensity of joint space and destruction of articular surface | |||
Radiography | Radiography | ||
*Joint space narrowing with destruction of joint space | *Joint space narrowing with destruction of joint space | ||
Nuclear imaging | Nuclear imaging | ||
*Focal uptake of gallium-67 and technetium-99m in area of destruction | *Focal uptake of gallium-67 and technetium-99m in area of destruction | ||
| | | | ||
Line 814: | Line 990: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
|Radiography | |Radiography | ||
*Wedge-shaped vertebra | *Wedge-shaped vertebra | ||
*Arcuate kyphosis | *Arcuate [[kyphosis]] | ||
*Narrow intervertebral discs with calcifications | *Narrow intervertebral discs with calcifications | ||
*Prominent irregularities of the vertebrae | *Prominent irregularities of the vertebrae | ||
*Vertebral plates are underdeveloped and demonstrate multiple herniations of the nucleus pulposus (Schmorl nodes) | *Vertebral plates are underdeveloped and demonstrate multiple herniations of the [[nucleus pulposus]] (Schmorl nodes) | ||
| | | | ||
*Schmorl nodes are also seen in Wilson's disease and are not specific | *Schmorl nodes are also seen in Wilson's disease and are not specific | ||
Line 843: | Line 1,020: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
|Radiography | |Radiography | ||
*Bending of the thoracic curve is noted | *Bending of the thoracic curve is noted | ||
MRI | MRI | ||
*Used to assess additional complaints such as | |||
*Used to assess additional complaints such as [[headache]]s, not routine for adolescents | |||
| | | | ||
*Most commonly is idiopathic | *Most commonly is [[idiopathic]] | ||
|- | |- | ||
![[Spinal stenosis]]<ref name="pmid18287604">{{cite journal |vauthors=Katz JN, Harris MB |title=Clinical practice. Lumbar spinal stenosis |journal=N. Engl. J. Med. |volume=358 |issue=8 |pages=818–25 |date=February 2008 |pmid=18287604 |doi=10.1056/NEJMcp0708097 |url=}}</ref><ref name="pmid8600197">{{cite journal |vauthors=Ciol MA, Deyo RA, Howell E, Kreif S |title=An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations |journal=J Am Geriatr Soc |volume=44 |issue=3 |pages=285–90 |date=March 1996 |pmid=8600197 |doi= |url=}}</ref> | ![[Spinal stenosis]]<ref name="pmid18287604">{{cite journal |vauthors=Katz JN, Harris MB |title=Clinical practice. Lumbar spinal stenosis |journal=N. Engl. J. Med. |volume=358 |issue=8 |pages=818–25 |date=February 2008 |pmid=18287604 |doi=10.1056/NEJMcp0708097 |url=}}</ref><ref name="pmid8600197">{{cite journal |vauthors=Ciol MA, Deyo RA, Howell E, Kreif S |title=An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations |journal=J Am Geriatr Soc |volume=44 |issue=3 |pages=285–90 |date=March 1996 |pmid=8600197 |doi= |url=}}</ref> | ||
Line 870: | Line 1,050: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
|MRI | |MRI | ||
*Demonstrates narrowing of central canal, lateral recess, and neuronal foramina | *Demonstrates narrowing of central canal, lateral recess, and neuronal foramina | ||
CT | CT | ||
*Demonstrates narrowing of central canal, lateral recess, and neuronal foramina | *Demonstrates narrowing of central canal, lateral recess, and neuronal foramina | ||
| | | | ||
Line 898: | Line 1,081: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
|Radiography | |Radiography | ||
*Demonstrates osteophytes and disc-space narrowing | *Demonstrates osteophytes and disc-space narrowing | ||
MRI | MRI | ||
*Demonstrates the location of destruction and surrounding soft tissue | *Demonstrates the location of destruction and surrounding soft tissue | ||
CT myelography | CT myelography | ||
*Demonstrates osteophytes and calcified opacities | *Demonstrates osteophytes and calcified opacities | ||
| | | | ||
Line 907: | Line 1,095: | ||
|- | |- | ||
![[Compression fracture|Vertebral compression fracture]]<ref name="pmid10692972">{{cite journal |vauthors=Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N |title=Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis |journal=Osteoporos Int |volume=10 |issue=4 |pages=259–64 |date=1999 |pmid=10692972 |doi= |url=}}</ref><ref name="pmid10994823">{{cite journal |vauthors=Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE |title=Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group |journal=Mayo Clin. Proc. |volume=75 |issue=9 |pages=888–96 |date=September 2000 |pmid=10994823 |doi= |url=}}</ref><ref name="pmid12208381">{{cite journal |vauthors=Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N |title=Diagnosis and management of vertebral fractures in elderly adults |journal=Am. J. Med. |volume=113 |issue=3 |pages=220–8 |date=August 2002 |pmid=12208381 |doi= |url=}}</ref> | ![[Compression fracture|Vertebral compression fracture]]<ref name="pmid10692972">{{cite journal |vauthors=Genant HK, Cooper C, Poor G, Reid I, Ehrlich G, Kanis J, Nordin BE, Barrett-Connor E, Black D, Bonjour JP, Dawson-Hughes B, Delmas PD, Dequeker J, Ragi Eis S, Gennari C, Johnell O, Johnston CC, Lau EM, Liberman UA, Lindsay R, Martin TJ, Masri B, Mautalen CA, Meunier PJ, Khaltaev N |title=Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis |journal=Osteoporos Int |volume=10 |issue=4 |pages=259–64 |date=1999 |pmid=10692972 |doi= |url=}}</ref><ref name="pmid10994823">{{cite journal |vauthors=Vogt TM, Ross PD, Palermo L, Musliner T, Genant HK, Black D, Thompson DE |title=Vertebral fracture prevalence among women screened for the Fracture Intervention Trial and a simple clinical tool to screen for undiagnosed vertebral fractures. Fracture Intervention Trial Research Group |journal=Mayo Clin. Proc. |volume=75 |issue=9 |pages=888–96 |date=September 2000 |pmid=10994823 |doi= |url=}}</ref><ref name="pmid12208381">{{cite journal |vauthors=Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N |title=Diagnosis and management of vertebral fractures in elderly adults |journal=Am. J. Med. |volume=113 |issue=3 |pages=220–8 |date=August 2002 |pmid=12208381 |doi= |url=}}</ref> | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
|Sudden, severe, sharp | |Sudden, severe, sharp | ||
Line 925: | Line 1,113: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Decreased hematocrit and anemia | |||
PSA | *Decreased [[hematocrit]] and [[anemia]] | ||
*To rule out prostatic cancer | |||
[[PSA]] | |||
*To rule out [[prostatic cancer|prostate cancer]] | |||
Urine analysis | Urine analysis | ||
*To detect Bence - Jones protein | *To detect Bence - Jones protein | ||
Serum protein electrophoresis | |||
*M spike is seen with multiple myeloma | Serum protein [[electrophoresis]] | ||
*M spike is seen with [[multiple myeloma]] | |||
ESR | ESR | ||
*May be elevated | *May be elevated | ||
|Radiography | |Radiography | ||
*Decreased vertebral body height | *Decreased vertebral body height | ||
CT | CT | ||
*Detects more subtle fractures and calcifications | *Detects more subtle fractures and calcifications | ||
MRI | MRI | ||
*Useful in those with motor weakness and sensory deficits | *Useful in those with motor weakness and sensory deficits | ||
*May demonstrate hemorrhage, tumor, or infection | *May demonstrate hemorrhage, tumor, or infection | ||
DRA scanning | DRA scanning | ||
*Detects low bone density | *Detects low bone density | ||
PET scanning | PET scanning | ||
*To distinguish benign from malignant causes of compression | |||
*To distinguish benign from malignant causes of compression | |||
| | | | ||
*Presents as a midline back pain | *Presents as a midline back pain | ||
|- | |- | ||
![[Vertebral osteomyelitis]]<ref name="pmid11515764">{{cite journal |vauthors=Beronius M, Bergman B, Andersson R |title=Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95 |journal=Scand. J. Infect. Dis. |volume=33 |issue=7 |pages=527–32 |date=2001 |pmid=11515764 |doi= |url=}}</ref><ref name="pmid370121">{{cite journal |vauthors=Digby JM, Kersley JB |title=Pyogenic non-tuberculous spinal infection: an analysis of thirty cases |journal=J Bone Joint Surg Br |volume=61 |issue=1 |pages=47–55 |date=February 1979 |pmid=370121 |doi= |url=}}</ref><ref name="pmid1775852">{{cite journal |vauthors=McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR |title=Vertebral osteomyelitis and aortic lesions: case report and review |journal=Rev. Infect. Dis. |volume=13 |issue=6 |pages=1184–94 |date=1991 |pmid=1775852 |doi= |url=}}</ref> | ![[Vertebral osteomyelitis]]<ref name="pmid11515764">{{cite journal |vauthors=Beronius M, Bergman B, Andersson R |title=Vertebral osteomyelitis in Göteborg, Sweden: a retrospective study of patients during 1990-95 |journal=Scand. J. Infect. Dis. |volume=33 |issue=7 |pages=527–32 |date=2001 |pmid=11515764 |doi= |url=}}</ref><ref name="pmid370121">{{cite journal |vauthors=Digby JM, Kersley JB |title=Pyogenic non-tuberculous spinal infection: an analysis of thirty cases |journal=J Bone Joint Surg Br |volume=61 |issue=1 |pages=47–55 |date=February 1979 |pmid=370121 |doi= |url=}}</ref><ref name="pmid1775852">{{cite journal |vauthors=McHenry MC, Rehm SJ, Krajewski LP, Duchesneau PM, Levin HS, Steinmuller DR |title=Vertebral osteomyelitis and aortic lesions: case report and review |journal=Rev. Infect. Dis. |volume=13 |issue=6 |pages=1184–94 |date=1991 |pmid=1775852 |doi= |url=}}</ref> | ||
Line 967: | Line 1,173: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
* Leukocytosis and left shift | |||
*[[Leukocytosis]] and left shift | |||
ESR | ESR | ||
* Elevated | |||
*Elevated | |||
CRP | CRP | ||
* Elevated | |||
*Elevated | |||
Procalcitonin | Procalcitonin | ||
* Elevated | |||
*Elevated | |||
Culture and sensitivity | Culture and sensitivity | ||
* To identify causative agent | |||
*To identify causative agent | |||
|Radiography | |Radiography | ||
* Demonstrates endosteal or medullary lesion | |||
* Sequestration and cavity formation | *Demonstrates endosteal or medullary lesion | ||
*Sequestration and cavity formation | |||
MRI | MRI | ||
* Bone marrow abnormalities and lytic changes | |||
*[[Bone marrow]] abnormalities and lytic changes | |||
CT | CT | ||
* Articular and periarticular involvement | |||
*Articular and periarticular involvement | |||
Ultrasound | Ultrasound | ||
* Soft tissue abnormalities | |||
*Soft tissue abnormalities | |||
Nuclear imaging | Nuclear imaging | ||
* Loss of bone density | |||
*Loss of bone density | |||
| | | | ||
*Often caused by hematogenous spread of organism | *Often caused by hematogenous spread of organism | ||
Line 1,003: | Line 1,227: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
Line 1,043: | Line 1,267: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in: | |Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in: | ||
* Complete blood count; normochromic normocytic anemia seen in haemorrhage | |||
* Elevated serum electrolytes | *Complete blood count; normochromic normocytic anemia seen in haemorrhage | ||
* Elevated liver function | *Elevated serum electrolytes | ||
* Elevated amylase or lipase | *Elevated [[liver function test]]s | ||
*Elevated [[amylase]] or [[lipase]] | |||
|Ultrasonography | |Ultrasonography | ||
* Visualization of aneurysm, size and/or rupture and hematoma | |||
*Visualization of aneurysm, size and/or rupture and hematoma | |||
Chest radiography | Chest radiography | ||
* Visualizes calcifications in aneurysm but not specific | |||
*Visualizes calcifications in aneurysm but not specific | |||
CT | CT | ||
* Demonstrates aortic size, extent, and involvement of organ arteries | |||
*Demonstrates aortic size, extent, and involvement of organ arteries | |||
MRI | MRI | ||
* Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT | |||
Angiography | *Has advantage of less radiation and no use for dye, whilst demonstrating same findings as [[ultrasound]] and [[CT]] | ||
* Allows 3D construction of aorta | |||
Echocardiography (Transesophageal) | [[Angiography]] | ||
* Demonstrates fluid shift and need for cardiology intervention | |||
*Allows 3D construction of aorta | |||
[[Echocardiography]] (Transesophageal) | |||
*Demonstrates fluid shift and need for cardiology intervention | |||
| | | | ||
* Livedo reticularis may be seen and indicates thrombotic phenomenon | *[[Livedo reticularis]] may be seen and indicates thrombotic phenomenon | ||
|- | |- | ||
![[Aortic dissection]]<ref name="pmid20717014">{{cite journal |vauthors=Suzuki T, Distante A, Eagle K |title=Biomarker-assisted diagnosis of acute aortic dissection: how far we have come and what to expect |journal=Curr. Opin. Cardiol. |volume=25 |issue=6 |pages=541–5 |date=November 2010 |pmid=20717014 |doi=10.1097/HCO.0b013e32833e6e13 |url=}}</ref><ref name="pmid29146682">{{cite journal |vauthors=Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, Zhu J, Sun L, Zhang H, Huang L, Zhao D, Gao P, Du J |title=Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection |journal=Circulation |volume=137 |issue=3 |pages=259–269 |date=January 2018 |pmid=29146682 |doi=10.1161/CIRCULATIONAHA.117.030469 |url=}}</ref><ref name="pmid27666178">{{cite journal |vauthors=Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W |title=Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=118 |issue=9 |pages=1405–1409 |date=November 2016 |pmid=27666178 |doi=10.1016/j.amjcard.2016.07.052 |url=}}</ref><ref name="pmid27666178" /><ref name="pmid11015167">{{cite journal |vauthors=Suzuki T, Katoh H, Tsuchio Y, Hasegawa A, Kurabayashi M, Ohira A, Hiramori K, Sakomura Y, Kasanuki H, Hori S, Aikawa N, Abe S, Tei C, Nakagawa Y, Nobuyoshi M, Misu K, Sumiyoshi T, Nagai R |title=Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study |journal=Ann. Intern. Med. |volume=133 |issue=7 |pages=537–41 |date=October 2000 |pmid=11015167 |doi= |url=}}</ref><ref name="pmid24036495">{{cite journal |vauthors=Marshall LM, Carlson EJ, O'Malley J, Snyder CK, Charbonneau NL, Hayflick SJ, Coselli JS, Lemaire SA, Sakai LY |title=Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation |journal=Circ. Res. |volume=113 |issue=10 |pages=1159–68 |date=October 2013 |pmid=24036495 |doi=10.1161/CIRCRESAHA.113.301498 |url=}}</ref> | ![[Aortic dissection]]<ref name="pmid20717014">{{cite journal |vauthors=Suzuki T, Distante A, Eagle K |title=Biomarker-assisted diagnosis of acute aortic dissection: how far we have come and what to expect |journal=Curr. Opin. Cardiol. |volume=25 |issue=6 |pages=541–5 |date=November 2010 |pmid=20717014 |doi=10.1097/HCO.0b013e32833e6e13 |url=}}</ref><ref name="pmid29146682">{{cite journal |vauthors=Wang Y, Tan X, Gao H, Yuan H, Hu R, Jia L, Zhu J, Sun L, Zhang H, Huang L, Zhao D, Gao P, Du J |title=Magnitude of Soluble ST2 as a Novel Biomarker for Acute Aortic Dissection |journal=Circulation |volume=137 |issue=3 |pages=259–269 |date=January 2018 |pmid=29146682 |doi=10.1161/CIRCULATIONAHA.117.030469 |url=}}</ref><ref name="pmid27666178">{{cite journal |vauthors=Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W |title=Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection |journal=Am. J. Cardiol. |volume=118 |issue=9 |pages=1405–1409 |date=November 2016 |pmid=27666178 |doi=10.1016/j.amjcard.2016.07.052 |url=}}</ref><ref name="pmid27666178" /><ref name="pmid11015167">{{cite journal |vauthors=Suzuki T, Katoh H, Tsuchio Y, Hasegawa A, Kurabayashi M, Ohira A, Hiramori K, Sakomura Y, Kasanuki H, Hori S, Aikawa N, Abe S, Tei C, Nakagawa Y, Nobuyoshi M, Misu K, Sumiyoshi T, Nagai R |title=Diagnostic implications of elevated levels of smooth-muscle myosin heavy-chain protein in acute aortic dissection. The smooth muscle myosin heavy chain study |journal=Ann. Intern. Med. |volume=133 |issue=7 |pages=537–41 |date=October 2000 |pmid=11015167 |doi= |url=}}</ref><ref name="pmid24036495">{{cite journal |vauthors=Marshall LM, Carlson EJ, O'Malley J, Snyder CK, Charbonneau NL, Hayflick SJ, Coselli JS, Lemaire SA, Sakai LY |title=Thoracic aortic aneurysm frequency and dissection are associated with fibrillin-1 fragment concentrations in circulation |journal=Circ. Res. |volume=113 |issue=10 |pages=1159–68 |date=October 2013 |pmid=24036495 |doi=10.1161/CIRCRESAHA.113.301498 |url=}}</ref> | ||
Line 1,081: | Line 1,317: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Elevations in: | |Elevations in: | ||
* Smooth muscle myosin heavy chain | *[[D - dimer]] | ||
* Soluble ST2 | *Smooth muscle myosin heavy chain | ||
* Soluble elastin fragments | *Soluble ST2 | ||
* High -sensitivity C-reactive protein | *Soluble elastin fragments | ||
* Fibrinogen | *High -sensitivity C-reactive protein | ||
* Fibrillin fragments | *[[Fibrinogen]] | ||
*Fibrillin fragments | |||
|ECG: | |ECG: | ||
* Normal | |||
* Non - specific ST wave changes | *Normal | ||
* Hypertrophy patterns | *Non - specific ST wave changes | ||
* ST segment elevation indicating myocardial infarction | *Hypertrophy patterns | ||
*ST segment elevation indicating myocardial infarction | |||
Chest radiography: | Chest radiography: | ||
* Normal | |||
* Mediastinal or aortic widening | *Normal | ||
*Mediastinal or aortic widening | |||
| | | | ||
* Increased risk of occurence with Marfan syndrome | *Increased risk of occurence with [[Marfan syndrome]] | ||
|- | |- | ||
![[Appendicitis]]<ref name="pmid9015177">{{cite journal |vauthors=Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH |title=Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis |journal=World J Surg |volume=21 |issue=3 |pages=313–7 |date=1997 |pmid=9015177 |doi= |url=}}</ref><ref name="pmid22071846">{{cite journal |vauthors=Wilms IM, de Hoog DE, de Visser DC, Janzing HM |title=Appendectomy versus antibiotic treatment for acute appendicitis |journal=Cochrane Database Syst Rev |volume= |issue=11 |pages=CD008359 |date=November 2011 |pmid=22071846 |doi=10.1002/14651858.CD008359.pub2 |url=}}</ref><ref name="pmid17192449">{{cite journal |vauthors=Becker T, Kharbanda A, Bachur R |title=Atypical clinical features of pediatric appendicitis |journal=Acad Emerg Med |volume=14 |issue=2 |pages=124–9 |date=February 2007 |pmid=17192449 |doi=10.1197/j.aem.2006.08.009 |url=}}</ref> | ![[Appendicitis]]<ref name="pmid9015177">{{cite journal |vauthors=Körner H, Söndenaa K, Söreide JA, Andersen E, Nysted A, Lende TH, Kjellevold KH |title=Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis |journal=World J Surg |volume=21 |issue=3 |pages=313–7 |date=1997 |pmid=9015177 |doi= |url=}}</ref><ref name="pmid22071846">{{cite journal |vauthors=Wilms IM, de Hoog DE, de Visser DC, Janzing HM |title=Appendectomy versus antibiotic treatment for acute appendicitis |journal=Cochrane Database Syst Rev |volume= |issue=11 |pages=CD008359 |date=November 2011 |pmid=22071846 |doi=10.1002/14651858.CD008359.pub2 |url=}}</ref><ref name="pmid17192449">{{cite journal |vauthors=Becker T, Kharbanda A, Bachur R |title=Atypical clinical features of pediatric appendicitis |journal=Acad Emerg Med |volume=14 |issue=2 |pages=124–9 |date=February 2007 |pmid=17192449 |doi=10.1197/j.aem.2006.08.009 |url=}}</ref> | ||
|Acute | |Acute | ||
|Minutes to hours | |Minutes to hours | ||
|Burning | |Burning | ||
|Umbilicus and lower right quadrant | |Umbilicus and lower right quadrant | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 1,119: | Line 1,358: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Demonstrates leukocytosis and neutrophilia | |||
*Demonstrates [[leukocytosis]] and [[neutrophilia]] | |||
CRP | CRP | ||
*May be elevated | *May be elevated | ||
Urine analysis | Urine analysis | ||
*May demonstrate pyuria, hematuria, and/or proteinuria | |||
*May demonstrate [[pyuria]], [[hematuria]], and/or [[proteinuria]] | |||
Urine 5-HIAA | Urine 5-HIAA | ||
*Maybe an early marker of appendictis | |||
*Sudden increase may indicate necrosis | *Maybe an early marker of [[appendictis]] | ||
*Sudden increase may indicate [[necrosis]] | |||
|Ultrasound | |Ultrasound | ||
*Demonstrates a non-compressible tubular structure | *Demonstrates a non-compressible tubular structure | ||
CT | CT | ||
*Demonstrates an enlarged appendix with thickened walls and can detect abnormally located appendices | |||
*Demonstrates an enlarged [[appendix]] with thickened walls and can detect abnormally located appendices | |||
MRI | MRI | ||
*Useful in pregnant ladies | *Useful in pregnant ladies | ||
KUB Radiography | KUB Radiography | ||
*May detect an appendicolith | *May detect an appendicolith | ||
Barium enema | |||
[[Barium enema]] | |||
*Demonstrates absent or incomplete filling | *Demonstrates absent or incomplete filling | ||
*Cecal spasm may be present | *Cecal spasm may be present | ||
Radionuclide scanning | Radionuclide scanning | ||
*Appendiceal inflammation may be present | *Appendiceal inflammation may be present | ||
| | | | ||
*Pain begins around the umbilicus and then shifts to RUQ | *Pain begins around the [[umbilicus]] and then shifts to [[RUQ]] | ||
|- | |- | ||
![[Gallstone disease|Cholelithiasis]]<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |date=July 1990 |pmid=2368790 |doi= |url=}}</ref><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |date=April 2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref> | ![[Gallstone disease|Cholelithiasis]]<ref name="pmid2368790">{{cite journal |vauthors=Diehl AK, Sugarek NJ, Todd KH |title=Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis |journal=Am. J. Med. |volume=89 |issue=1 |pages=29–33 |date=July 1990 |pmid=2368790 |doi= |url=}}</ref><ref name="pmid19190960">{{cite journal |vauthors=Fitzgerald JE, White MJ, Lobo DN |title=Courvoisier's gallbladder: law or sign? |journal=World J Surg |volume=33 |issue=4 |pages=886–91 |date=April 2009 |pmid=19190960 |doi=10.1007/s00268-008-9908-y |url=}}</ref> | ||
Line 1,162: | Line 1,419: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Demonstrates polymorphnuclear leukocytosis | |||
*Demonstrates polymorphnuclear [[leukocytosis]] | |||
LFT | LFT | ||
*Elevated alanine aminotransferase and aspartate aminotransferases | |||
*Elevated conjugated bilirubin | *Elevated [[alanine aminotransferase]] and [[aspartate aminotransferases]] | ||
Amylase and lipase | *Elevated conjugated [[bilirubin]] | ||
[[Amylase]] and [[lipase]] | |||
*Elevated | *Elevated | ||
|Radiography | |Radiography | ||
*Radio-opaque stones may be present | *Radio-opaque stones may be present | ||
CT | CT | ||
*May indicate presence of gallstones in the distal common bile duct | |||
*May indicate presence of [[gallstones]] in the distal [[common bile duct]] | |||
MRI | MRI | ||
**May indicate presence of gallstones in the distal common bile duct | |||
**May indicate presence of [[gallstones]] in the distal [[common bile duct]] | |||
Ultrasound | Ultrasound | ||
*May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention | |||
*Gallstones may appear as echogenic foci that cast an acoustic shadow | *May demonstrate gallbladder wall thickening (>5 mm) and gallbladder fluid and distention | ||
*Gallstones may appear as echogenic foci that cast an [[acoustic shadow]] | |||
Scintigraphy | Scintigraphy | ||
*May detect cystic duct obstruction | *May detect cystic duct obstruction | ||
ERCP | ERCP | ||
*Stones are seen as a filling defect and can be removed simultaneously | *Stones are seen as a filling defect and can be removed simultaneously | ||
PTC | PTC | ||
*Similar to ERCP | *Similar to ERCP | ||
*Used when ERCP is not feasible | *Used when ERCP is not feasible | ||
Line 1,199: | Line 1,474: | ||
|<nowiki>+/- </nowiki> | |<nowiki>+/- </nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>- </nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>+/-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| - | | - | ||
|Detection of: | |Detection of: | ||
* Toll-like receptors 2 and 4 (TLR-2 and TLR-4) on platelets | *Urinary proton nuclear magnetic resonance spectroscopy | ||
*Toll-like receptors 2 and 4 (TLR-2 and TLR-4) on platelets | |||
|Chest radiography | |Chest radiography | ||
* Normal, may show calcification or complications such as pleural effusion | |||
*Normal, may show [[calcification]] or complications such as [[pleural effusion]] | |||
Exercise stress testing | Exercise stress testing | ||
* Establishes diagnosis and extent of angina | |||
*Establishes diagnosis and extent of [[angina]] | |||
Stress Echo | Stress Echo | ||
* To evaluate wall motion, normal in stable angina | |||
*To evaluate wall motion, normal in [[stable angina]] | |||
Nuclear imaging | Nuclear imaging | ||
* To assess myocardial perfusion, reduced in stable angina | |||
*To assess myocardial perfusion, reduced in [[stable angina]] | |||
CT | CT | ||
* To evaluate coronary artery calcium (cac) which may or may not be elevated | |||
*To evaluate coronary artery calcium (cac) which may or may not be elevated | |||
CT Angiography | CT Angiography | ||
* To evaluate stenosis, <70% in stable angina | |||
*To evaluate [[stenosis]], <70% in [[stable angina]] | |||
EKG | EKG | ||
* Normal in stable angina | |||
*Normal in [[stable angina]] | |||
| | | | ||
* Hallmark is relief by rest or sublingual nitroglycerin | *Hallmark is relief by rest or sublingual [[nitroglycerin]] | ||
|- | |- | ||
![[Cystitis]]<ref name="pmid24484571">{{cite journal |vauthors=Foxman B |title=Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden |journal=Infect. Dis. Clin. North Am. |volume=28 |issue=1 |pages=1–13 |date=March 2014 |pmid=24484571 |doi=10.1016/j.idc.2013.09.003 |url=}}</ref><ref name="pmid22417256">{{cite journal |vauthors=Hooton TM |title=Clinical practice. Uncomplicated urinary tract infection |journal=N. Engl. J. Med. |volume=366 |issue=11 |pages=1028–37 |date=March 2012 |pmid=22417256 |doi=10.1056/NEJMcp1104429 |url=}}</ref><ref name="pmid22393148">{{cite journal |vauthors=Gupta K, Trautner B |title=In the clinic. Urinary tract infection |journal=Ann. Intern. Med. |volume=156 |issue=5 |pages=ITC3–1–ITC3–15; quiz ITC3–16 |date=March 2012 |pmid=22393148 |doi=10.7326/0003-4819-156-5-201203060-01003 |url=}}</ref> | ![[Cystitis]]<ref name="pmid24484571">{{cite journal |vauthors=Foxman B |title=Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden |journal=Infect. Dis. Clin. North Am. |volume=28 |issue=1 |pages=1–13 |date=March 2014 |pmid=24484571 |doi=10.1016/j.idc.2013.09.003 |url=}}</ref><ref name="pmid22417256">{{cite journal |vauthors=Hooton TM |title=Clinical practice. Uncomplicated urinary tract infection |journal=N. Engl. J. Med. |volume=366 |issue=11 |pages=1028–37 |date=March 2012 |pmid=22417256 |doi=10.1056/NEJMcp1104429 |url=}}</ref><ref name="pmid22393148">{{cite journal |vauthors=Gupta K, Trautner B |title=In the clinic. Urinary tract infection |journal=Ann. Intern. Med. |volume=156 |issue=5 |pages=ITC3–1–ITC3–15; quiz ITC3–16 |date=March 2012 |pmid=22393148 |doi=10.7326/0003-4819-156-5-201203060-01003 |url=}}</ref> | ||
Line 1,242: | Line 1,531: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
||Urine analysis | ||Urine analysis | ||
*May demonstrate pyuria, hematuria, white blood cell casts and proteinuria | |||
*May demonstrate [[pyuria[[, [[hematuria]], [[white blood cell]] casts and [[proteinuria]] | |||
Urine culture | Urine culture | ||
*Detection of > 1000 colony-forming units/ml | *Detection of > 1000 colony-forming units/ml | ||
CBC | CBC | ||
*May demonstrate leukocytosis and/or anemia | |||
*May demonstrate [[leukocytosis]] and/or [[anemia]] | |||
| | | | ||
*Typically no routine imaging done | *Typically no routine imaging done | ||
| | | | ||
*Cystitis may be infectious, hemorrhagic, radiational, or sterile | *Cystitis may be infectious, hemorrhagic, radiational, or sterile | ||
|- | |- | ||
![[Endocarditis]]<ref name="pmid26320109">{{cite journal |vauthors=Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL |title=2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) |journal=Eur. Heart J. |volume=36 |issue=44 |pages=3075–3128 |date=November 2015 |pmid=26320109 |doi=10.1093/eurheartj/ehv319 |url=}}</ref><ref name="pmid11479467">{{cite journal |vauthors=Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A |title=Cardiac conduction abnormalities in endocarditis defined by the Duke criteria |journal=Am. Heart J. |volume=142 |issue=2 |pages=280–5 |date=August 2001 |pmid=11479467 |doi=10.1067/mhj.2001.116964 |url=}}</ref><ref name="pmid26341945">{{cite journal |vauthors=Cahill TJ, Prendergast BD |title=Infective endocarditis |journal=Lancet |volume=387 |issue=10021 |pages=882–93 |date=February 2016 |pmid=26341945 |doi=10.1016/S0140-6736(15)00067-7 |url=}}</ref> | ![[Endocarditis]]<ref name="pmid26320109">{{cite journal |vauthors=Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL |title=2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM) |journal=Eur. Heart J. |volume=36 |issue=44 |pages=3075–3128 |date=November 2015 |pmid=26320109 |doi=10.1093/eurheartj/ehv319 |url=}}</ref><ref name="pmid11479467">{{cite journal |vauthors=Meine TJ, Nettles RE, Anderson DJ, Cabell CH, Corey GR, Sexton DJ, Wang A |title=Cardiac conduction abnormalities in endocarditis defined by the Duke criteria |journal=Am. Heart J. |volume=142 |issue=2 |pages=280–5 |date=August 2001 |pmid=11479467 |doi=10.1067/mhj.2001.116964 |url=}}</ref><ref name="pmid26341945">{{cite journal |vauthors=Cahill TJ, Prendergast BD |title=Infective endocarditis |journal=Lancet |volume=387 |issue=10021 |pages=882–93 |date=February 2016 |pmid=26341945 |doi=10.1016/S0140-6736(15)00067-7 |url=}}</ref> | ||
Line 1,274: | Line 1,568: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Anemia and leukocytosis may be noted | |||
*[[Anemia]] and [[leukocytosis]] may be noted | |||
Serology | Serology | ||
*Decrease C3, C4, and CH50 may indicate subacute endocarditis | |||
*Rheumatoid factor may be positive | *Decrease C3, C4, and CH50 may indicate [[subacute endocarditis]] | ||
*[[Rheumatoid factor]] may be positive | |||
ESR | ESR | ||
*May be elevated | *May be elevated | ||
Urine analysis | Urine analysis | ||
*May demonstrate proteinuria and microscopic hematuria | |||
*May demonstrate [[proteinuria]] and microscopic [[hematuria]] | |||
Blood culture | Blood culture | ||
*To identify causative agent | *To identify causative agent | ||
*Streptococci and HACEK organisms are culture negative | *Streptococci and HACEK organisms are culture negative | ||
*Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci | *Organisms that grow on prosthetic valves tend to be coagulase-negative staphylococci | ||
|Echocardiography | |Echocardiography | ||
*Vegetations and myocardial abscesses may be present | *Vegetations and myocardial abscesses may be present | ||
Radiography | Radiography | ||
*Pyogenic emboli may be seen across the lung field | |||
*Pyogenic [[emboli]] may be seen across the lung field | |||
Ultrasound | Ultrasound | ||
*Myocardial abscesses may be seen | *Myocardial abscesses may be seen | ||
*Valvular dysfunction may also be noted | *Valvular dysfunction may also be noted | ||
| | | | ||
*IV drug users and those who suffer from rheumatic heart disease often present with infective endocarditis | *IV drug users and those who suffer from [[rheumatic heart disease]] often present with [[infective endocarditis]] | ||
|- | |- | ||
![[Myalgia]]<ref name="pmid7677303">{{cite journal |vauthors=Gumber SC, Chopra S |title=Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations |journal=Ann. Intern. Med. |volume=123 |issue=8 |pages=615–20 |date=October 1995 |pmid=7677303 |doi= |url=}}</ref><ref name="pmid3404526">{{cite journal |vauthors=Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D |title=Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase |journal=J R Soc Med |volume=81 |issue=6 |pages=326–9 |date=June 1988 |pmid=3404526 |pmc=1291623 |doi=10.1177/014107688808100608 |url=}}</ref><ref name="pmid18452688">{{cite journal |vauthors=Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD |title=Diagnosis and treatment of Lyme disease |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=566–71 |date=May 2008 |pmid=18452688 |doi=10.4065/83.5.566 |url=}}</ref> | ![[Myalgia]]<ref name="pmid7677303">{{cite journal |vauthors=Gumber SC, Chopra S |title=Hepatitis C: a multifaceted disease. Review of extrahepatic manifestations |journal=Ann. Intern. Med. |volume=123 |issue=8 |pages=615–20 |date=October 1995 |pmid=7677303 |doi= |url=}}</ref><ref name="pmid3404526">{{cite journal |vauthors=Archard LC, Bowles NE, Behan PO, Bell EJ, Doyle D |title=Postviral fatigue syndrome: persistence of enterovirus RNA in muscle and elevated creatine kinase |journal=J R Soc Med |volume=81 |issue=6 |pages=326–9 |date=June 1988 |pmid=3404526 |pmc=1291623 |doi=10.1177/014107688808100608 |url=}}</ref><ref name="pmid18452688">{{cite journal |vauthors=Bratton RL, Whiteside JW, Hovan MJ, Engle RL, Edwards FD |title=Diagnosis and treatment of Lyme disease |journal=Mayo Clin. Proc. |volume=83 |issue=5 |pages=566–71 |date=May 2008 |pmid=18452688 |doi=10.4065/83.5.566 |url=}}</ref> | ||
Line 1,315: | Line 1,623: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|*Typically no specific lab findings | |*Typically no specific lab findings | ||
*A full workup should be done to exclude other etiologies, such as; | *A full workup should be done to exclude other etiologies, such as; | ||
Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies | |||
*May indicate cause is rheumatoid arthritis | [[Rheumatoid factor]] and/or anti-cyclic citrullinated peptide antibodies | ||
*May indicate cause is [[rheumatoid arthritis]] | |||
CRP and ESR | CRP and ESR | ||
*May be elevated | |||
*May be elevated | |||
CBC | CBC | ||
*May indicate anemia | |||
*May indicate [[anemia]] | |||
Bone profile | Bone profile | ||
*May be caused by a vitamin D or calcium | |||
*May be caused by a [[vitamin D]] or calcium deficiency | |||
| | | | ||
*Typically no routine imaging done | *Typically no routine imaging done | ||
| | | | ||
*May be associated with Hepatitis C and Lyme disease | *May be associated with [[Hepatitis C]] and [[Lyme disease]] | ||
|- | |- | ||
![[Kidney stone|Nephrolithiasis]]<ref name="pmid23283137">{{cite journal |vauthors=Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z |title=Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States |journal=Kidney Int. |volume=83 |issue=3 |pages=479–86 |date=March 2013 |pmid=23283137 |pmc=3587650 |doi=10.1038/ki.2012.419 |url=}}</ref><ref name="pmid12618515">{{cite journal |vauthors=Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M |title=Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle |journal=J. Clin. Invest. |volume=111 |issue=5 |pages=607–16 |date=March 2003 |pmid=12618515 |pmc=151900 |doi=10.1172/JCI17038 |url=}}</ref><ref name="pmid15592050">{{cite journal |vauthors=Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP, Lingeman JE |title=Stone formation is proportional to papillary surface coverage by Randall's plaque |journal=J. Urol. |volume=173 |issue=1 |pages=117–9; discussion 119 |date=January 2005 |pmid=15592050 |doi=10.1097/01.ju.0000147270.68481.ce |url=}}</ref> | ![[Kidney stone|Nephrolithiasis]]<ref name="pmid23283137">{{cite journal |vauthors=Fwu CW, Eggers PW, Kimmel PL, Kusek JW, Kirkali Z |title=Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States |journal=Kidney Int. |volume=83 |issue=3 |pages=479–86 |date=March 2013 |pmid=23283137 |pmc=3587650 |doi=10.1038/ki.2012.419 |url=}}</ref><ref name="pmid12618515">{{cite journal |vauthors=Evan AP, Lingeman JE, Coe FL, Parks JH, Bledsoe SB, Shao Y, Sommer AJ, Paterson RF, Kuo RL, Grynpas M |title=Randall's plaque of patients with nephrolithiasis begins in basement membranes of thin loops of Henle |journal=J. Clin. Invest. |volume=111 |issue=5 |pages=607–16 |date=March 2003 |pmid=12618515 |pmc=151900 |doi=10.1172/JCI17038 |url=}}</ref><ref name="pmid15592050">{{cite journal |vauthors=Kim SC, Coe FL, Tinmouth WW, Kuo RL, Paterson RF, Parks JH, Munch LC, Evan AP, Lingeman JE |title=Stone formation is proportional to papillary surface coverage by Randall's plaque |journal=J. Urol. |volume=173 |issue=1 |pages=117–9; discussion 119 |date=January 2005 |pmid=15592050 |doi=10.1097/01.ju.0000147270.68481.ce |url=}}</ref> | ||
|Acute | |Acute | ||
|Hours | |Hours | ||
|Severe, sharp | |Severe, sharp | ||
|Abdomen, hips, groin, legs | |Abdomen, hips, groin, legs | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 1,348: | Line 1,665: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Mild leukocytosis may indicate infection | |||
*Mild [[leukocytosis]] may indicate infection | |||
Electrolytes | Electrolytes | ||
*Hypokalemia may indicate acute tubular necrosis | |||
*Hypercalcemia or hypercalciuria may be detected | *[[Hypokalemia]] may indicate [[acute tubular necrosis]] | ||
*[[Hypercalcemia]] or [[hypercalciuria]] may be detected | |||
Creatinine | Creatinine | ||
*To identify potential renal injury with contrast | *To identify potential renal injury with contrast | ||
Uric acid | Uric acid | ||
*Uric acid stones sometimes occur with gout | |||
*[[Uric acid]] stones sometimes occur with gout | |||
ABG | ABG | ||
*May indicate acute tubular necrosis with hypokalemia and decreased bicarbonate | |||
*May indicate [[acute tubular necrosis]] with [[hypokalemia]] and decreased bicarbonate | |||
|CT | |CT | ||
*Visualizes calcium stones and other possible pathologies, such as hydronephrosis | |||
*Visualizes [[calcium]] stones and other possible pathologies, such as [[hydronephrosis]] | |||
IVP | IVP | ||
*Visualizes stones and entire urinary system | *Visualizes stones and entire urinary system | ||
KUB radiography | KUB radiography | ||
*Radio-opaque stones may be present | *Radio-opaque stones may be present | ||
Ultrasound | Ultrasound | ||
*For visualization of stones | *For visualization of stones | ||
Plain renal tomography | Plain renal tomography | ||
*Can distinguish between intrarenal and extrarenal calcifications | *Can distinguish between intrarenal and extrarenal calcifications | ||
Retrograde pyelography | Retrograde pyelography | ||
*Particularly useful for | |||
*Particularly useful for ureteric calculi visualization | |||
Nuclear renal imaging | Nuclear renal imaging | ||
*May determine a decreased renal function | *May determine a decreased renal function | ||
| | | | ||
*Hypercalcemia may indicate primary or secondary hyperparathyroidism | *Hypercalcemia may indicate primary or secondary [[hyperparathyroidism]] | ||
|- | |- | ||
![[Pancreatitis]]<ref name="pmid15199038">{{cite journal |vauthors=Swaroop VS, Chari ST, Clain JE |title=Severe acute pancreatitis |journal=JAMA |volume=291 |issue=23 |pages=2865–8 |date=June 2004 |pmid=15199038 |doi=10.1001/jama.291.23.2865 |url=}}</ref><ref name="pmid12094843">{{cite journal |vauthors=Yadav D, Agarwal N, Pitchumoni CS |title=A critical evaluation of laboratory tests in acute pancreatitis |journal=Am. J. Gastroenterol. |volume=97 |issue=6 |pages=1309–18 |date=June 2002 |pmid=12094843 |doi=10.1111/j.1572-0241.2002.05766.x |url=}}</ref><ref name="pmid8540502">{{cite journal |vauthors=Fortson MR, Freedman SN, Webster PD |title=Clinical assessment of hyperlipidemic pancreatitis |journal=Am. J. Gastroenterol. |volume=90 |issue=12 |pages=2134–9 |date=December 1995 |pmid=8540502 |doi= |url=}}</ref> | ![[Pancreatitis]]<ref name="pmid15199038">{{cite journal |vauthors=Swaroop VS, Chari ST, Clain JE |title=Severe acute pancreatitis |journal=JAMA |volume=291 |issue=23 |pages=2865–8 |date=June 2004 |pmid=15199038 |doi=10.1001/jama.291.23.2865 |url=}}</ref><ref name="pmid12094843">{{cite journal |vauthors=Yadav D, Agarwal N, Pitchumoni CS |title=A critical evaluation of laboratory tests in acute pancreatitis |journal=Am. J. Gastroenterol. |volume=97 |issue=6 |pages=1309–18 |date=June 2002 |pmid=12094843 |doi=10.1111/j.1572-0241.2002.05766.x |url=}}</ref><ref name="pmid8540502">{{cite journal |vauthors=Fortson MR, Freedman SN, Webster PD |title=Clinical assessment of hyperlipidemic pancreatitis |journal=Am. J. Gastroenterol. |volume=90 |issue=12 |pages=2134–9 |date=December 1995 |pmid=8540502 |doi= |url=}}</ref> | ||
Line 1,394: | Line 1,733: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Amylase and lipase | |Amylase and lipase | ||
*Elevated | *Elevated | ||
LFT | LFT | ||
*Elevated alkaline phosphatase, total bilirubin, aspartate aminotransferase, and alanine aminotransferase | |||
*Elevated [[alkaline phosphatase]], total [[bilirubin]], [[aspartate aminotransferase]], and [[alanine aminotransferase]] | |||
CBC | CBC | ||
*May demonstrate leukocytosis | |||
*May demonstrate [[leukocytosis]] | |||
Serum electrolytes | Serum electrolytes | ||
*May indicate hypo or hypercalcemia | |||
*May indicate hypo or [[hypercalcemia]] | |||
BUN and creatinine | BUN and creatinine | ||
*May be elevated | *May be elevated | ||
Triglycerides | Triglycerides | ||
*Usually elevated, however, falsely lowered during acute attack | *Usually elevated, however, falsely lowered during acute attack | ||
|KUB radiography | |KUB radiography | ||
*May demonstrate free air within abdomen, indicating a perforated viscus | *May demonstrate free air within abdomen, indicating a perforated viscus | ||
Ultrasound | Ultrasound | ||
*Used to visualize the pancreas and biliary tree | *Used to visualize the pancreas and biliary tree | ||
*May detect microlithiasis and periampullary lesions | *May detect microlithiasis and periampullary lesions | ||
CT | CT | ||
*Pancreas may appear enlarged | |||
*[[Pancreas]] may appear enlarged | |||
MRC | MRC | ||
*May demonstrate a blockage within the biliary ducts | *May demonstrate a blockage within the biliary ducts | ||
ERCP | ERCP | ||
*May remove a blockage, however, can in fact cause pancreatitis | |||
*May remove a blockage, however, can in fact cause [[pancreatitis]] | |||
| | | | ||
*Usually caused by binge drinking or long standing gallstones that block the ampulla of Vater | *Usually caused by binge drinking or long standing gallstones that block the [[ampulla of Vater]] | ||
*Vomiting is a common manifestation | *[[Vomiting]] is a common manifestation | ||
|- | |- | ||
![[Pelvic inflammatory disease]]<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |date=May 2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid24216035">{{cite journal |vauthors=Ross J, Judlin P, Jensen J |title=2012 European guideline for the management of pelvic inflammatory disease |journal=Int J STD AIDS |volume=25 |issue=1 |pages=1–7 |date=January 2014 |pmid=24216035 |doi=10.1177/0956462413498714 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |date=June 2015 |pmid=26042815 |doi= |url=}}</ref> | ![[Pelvic inflammatory disease]]<ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |date=May 2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref><ref name="pmid24216035">{{cite journal |vauthors=Ross J, Judlin P, Jensen J |title=2012 European guideline for the management of pelvic inflammatory disease |journal=Int J STD AIDS |volume=25 |issue=1 |pages=1–7 |date=January 2014 |pmid=24216035 |doi=10.1177/0956462413498714 |url=}}</ref><ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |date=June 2015 |pmid=26042815 |doi= |url=}}</ref> | ||
Line 1,439: | Line 1,798: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Leukocytosis, may indicate infection with trichomoniasis | |||
*[[Leukocytosis]], may indicate infection with [[trichomoniasis]] | |||
Pregnancy test | Pregnancy test | ||
*To rule out ectopic pregnancy | |||
*To rule out [[ectopic pregnancy]] | |||
STD panel | STD panel | ||
*To rule out gonorrhea, chlamydia, hepatitis B and C, HIV, and syphilis | |||
*To rule out [[gonorrhea]], [[chlamydia]], [[hepatitis B]] and C, [[HIV]], and [[syphilis]] | |||
Urine analysis | Urine analysis | ||
*To rule out a urinary tract infection | |||
*To rule out a [[urinary tract infection]] | |||
|Transvaginal ultrasound | |Transvaginal ultrasound | ||
*May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx | *May demonstrate anechoic structures in adnexa indicating hydrosalpinx and/or pyosalpinx | ||
Laparoscopy | Laparoscopy | ||
*May demonstrate adhesions (Asherman's syndrome) or gun powder lesions (Endometriosis) or an ectopic pregnancy | |||
*May demonstrate adhesions (Asherman's syndrome) or gun powder lesions ([[Endometriosis]]) or an [[ectopic pregnancy]] | |||
MRI and CT | MRI and CT | ||
*May indicate hydro and/ or pyosalpinx | *May indicate hydro and/ or pyosalpinx | ||
| | | | ||
Line 1,460: | Line 1,831: | ||
|Severe, sharp | |Severe, sharp | ||
|Chest and back | |Chest and back | ||
|<nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 1,474: | Line 1,845: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Lab findings are not specfic and are done to rule out other diseases such as: | |Lab findings are not specfic and are done to rule out other diseases such as: | ||
*Antithrombin III deficiency | |||
*Protein C or protein S deficiency | *[[Antithrombin]] III deficiency | ||
*Lupus | *[[Protein C]]or [[protein S]] deficiency | ||
*[[Lupus]] | |||
*Homocystinuria | *Homocystinuria | ||
*Malignancy | *Malignancy | ||
Line 1,485: | Line 1,857: | ||
| | | | ||
*PE may occur even in patients that are fully anticoagulated | *PE may occur even in patients that are fully anticoagulated | ||
*DVT is a common source | *[[DVT]] is a common source | ||
|- | |- | ||
![[Pyelonephritis]]<ref name="pmid21292654">{{cite journal |vauthors=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE |title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases |journal=Clin. Infect. Dis. |volume=52 |issue=5 |pages=e103–20 |date=March 2011 |pmid=21292654 |doi=10.1093/cid/ciq257 |url=}}</ref> | ![[Pyelonephritis]]<ref name="pmid21292654">{{cite journal |vauthors=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE |title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases |journal=Clin. Infect. Dis. |volume=52 |issue=5 |pages=e103–20 |date=March 2011 |pmid=21292654 |doi=10.1093/cid/ciq257 |url=}}</ref> | ||
Line 1,503: | Line 1,875: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>+/-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CRP | |CRP | ||
*Elevated | *Elevated | ||
ESR | ESR | ||
*Elevated | *Elevated | ||
Urinalysis | Urinalysis | ||
*Pyuria | |||
*[[Pyuria]] | |||
*Bacteriuria | *Bacteriuria | ||
*May be nitrite positive (gram negative organisms) | *May be nitrite positive (gram negative organisms) | ||
*Culture positibe (Uncomplicated: E. coli, Proteus mirabialis, Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis | *Culture positibe (Uncomplicated: E. coli, [[Proteus mirabialis]], Klebsiella, S. saprophyticus- Complicated: E. coli, enterococci, S.epidermidis | ||
|Ultrasound | |Ultrasound | ||
*Hydronephrosis | |||
*[[Hydronephrosis]] | |||
Non-contrast CT | Non-contrast CT | ||
*Pelvicalceal dilation | *Pelvicalceal dilation | ||
*Cortical involvement | *Cortical involvement | ||
MRI | MRI | ||
*T1: affected region(s) appear hypointense compared with the normal kidney parenchyma | *T1: affected region(s) appear hypointense compared with the normal kidney parenchyma | ||
*T2: hyperintense compared to normal kidney parenchyma | *T2: hyperintense compared to normal kidney parenchyma | ||
*T1 C+: reduced enhancement | *T1 C+: reduced enhancement | ||
| | | | ||
*Renal stones | *Renal stones | ||
*Obstruction | *Obstruction | ||
*Pregnancy | *[[Pregnancy]] | ||
*Prolonged urinary catheterization | *Prolonged urinary catheterization | ||
|- | |- | ||
Line 1,548: | Line 1,930: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Leukocytosis is often demonstrated however, white blood cell count may be normal | |||
*[[Leukocytosis]] is often demonstrated however, [[white blood cell]] count may be normal | |||
Blood culture | Blood culture | ||
*To identify causative organism or rule out other organisms such as MRSA | *To identify causative organism or rule out other organisms such as MRSA | ||
|Radiography | |Radiography | ||
*Plain x-ray shows multiple patches in the lung fields | *Plain x-ray shows multiple patches in the lung fields | ||
CT | CT | ||
*Used to distinguish pneumonia from non-pneumonias | *Used to distinguish pneumonia from non-pneumonias | ||
| | | | ||
Line 1,577: | Line 1,965: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Demonstrates leukocytosis | |||
*Demonstrates [[leukocytosis]] | |||
ESR | ESR | ||
*Elevated | |||
Serum creatine kinase and aldolase | *Elevated | ||
Serum [[creatine kinase]] and [[aldolase ]] | |||
*Normal | *Normal | ||
Blood culture | Blood culture | ||
*Typically negative | *Typically negative | ||
Culture and sensitivity | Culture and sensitivity | ||
*May include a positive gram stain | *May include a positive gram stain | ||
|MRI | |MRI | ||
*Can differentiate between osteomyelitis and pyomyositis by demonstrating early muscle inflammation or abscess formation | |||
*Can differentiate between [[osteomyelitis]] and pyomyositis by demonstrating early muscle inflammation or abscess formation | |||
CT | CT | ||
*May demonstrate | |||
*May demonstrate pphypertrophy]] of muscles and/or effacement of fatty plane | |||
*An enhancement in contrast may indicate abscess formation | *An enhancement in contrast may indicate abscess formation | ||
Ultrasound | Ultrasound | ||
*Useful in determining specific muscle involvement | *Useful in determining specific muscle involvement | ||
Gallium scan | Gallium scan | ||
*Useful in detecting early muscle pathology | |||
*Useful in detecting early muscle pathology | |||
| | | | ||
*Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too | *Infectious myositis was once considered a tropical disease, however with the emergence of HIV is now prevalent in western societies too | ||
Line 1,617: | Line 2,021: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|ESR and CRP | |ESR and CRP | ||
*Elevated | *Elevated | ||
CBC | CBC | ||
*May indicate anemia | |||
Rheumatoid factor | *May indicate [[anemia]] | ||
[[Rheumatoid factor]] | |||
*May be positive | *May be positive | ||
ANA | ANA | ||
*May be positive | *May be positive | ||
Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV) | Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV) | ||
*Are specific to | |||
*Are specific to [[rheumatoid arthritis]] | |||
|Radiography | |Radiography | ||
*Osteopenia is noted | |||
*[[Osteopenia]] is noted | |||
*Metacarpal bone erosion | *Metacarpal bone erosion | ||
*Narrow joint space without osteophytes | *Narrow joint space without osteophytes | ||
MRI | MRI | ||
*Pannus formation may be noted | *Pannus formation may be noted | ||
Ultrasound | Ultrasound | ||
*Effusion of joint may be seen | *Effusion of joint may be seen | ||
| | | | ||
*Symmetric polyarthritis | *Symmetric polyarthritis | ||
*Morning stiffness with improvement throughout the day | *Morning stiffness with improvement throughout the day | ||
*Deformities of the hand are common | *Deformities of the hand are common | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Typically no specific lab findings, however, evidence of | |Typically no specific lab findings, however, evidence of [[hemorrhage]] and organ injury may be seen in: | ||
* Complete blood count; normochromic normocytic anemia seen in | |||
* Elevated serum electrolytes | *Complete blood count; [[normochromic normocytic anemia]] seen in [[hemorrhage]] | ||
* Elevated liver function tests | *Elevated serum electrolytes | ||
* Elevated amylase or lipase | *Elevated liver function tests | ||
*Elevated [[amylase]] or [[lipase]] | |||
|Ultrasonography | |Ultrasonography | ||
* Visualization of rupture, size and hematoma | |||
*Visualization of rupture, size and [[hematoma]] | |||
CT | CT | ||
* Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption, | |||
*Demonstrates intimal flap, hematoma, filling defect, aortic contour abnormality, pseudoaneurysm, vessel wall disruption, and extravasation of intravenous contrast | |||
MRI | MRI | ||
* Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT | |||
*Has advantage of less radiation and no use for dye, whilst demonstrating same findings as ultrasound and CT | |||
Angiography | Angiography | ||
* Allows 3D construction of aorta | |||
*Allows 3D construction of aorta | |||
Echocardiography (Transesophageal) | Echocardiography (Transesophageal) | ||
* Demonstrates fluid shift and need for cardiology intervention | |||
*Demonstrates fluid shift and need for cardiology intervention | |||
| | | | ||
* Mostly caused by automobile accidents | *Mostly caused by automobile accidents | ||
|- | |- | ||
![[Adrenal hemorrhage|Waterhouse-Friderichsen syndrome]]<ref name="pmid5006579">{{cite journal |vauthors=Migeon CJ, Kenny FM, Hung W, Voorhess ML |title=Study of adrenal function in children with meningitis |journal=Pediatrics |volume=40 |issue=2 |pages=163–83 |date=August 1967 |pmid=5006579 |doi= |url=}}</ref><ref name="pmid13932989">{{cite journal |vauthors=MARGARETTEN W, NAKAI H, LANDING BH |title=Septicemic adrenal hemorrhage |journal=Am. J. Dis. Child. |volume=105 |issue= |pages=346–51 |date=April 1963 |pmid=13932989 |doi= |url=}}</ref> | ![[Adrenal hemorrhage|Waterhouse-Friderichsen syndrome]]<ref name="pmid5006579">{{cite journal |vauthors=Migeon CJ, Kenny FM, Hung W, Voorhess ML |title=Study of adrenal function in children with meningitis |journal=Pediatrics |volume=40 |issue=2 |pages=163–83 |date=August 1967 |pmid=5006579 |doi= |url=}}</ref><ref name="pmid13932989">{{cite journal |vauthors=MARGARETTEN W, NAKAI H, LANDING BH |title=Septicemic adrenal hemorrhage |journal=Am. J. Dis. Child. |volume=105 |issue= |pages=346–51 |date=April 1963 |pmid=13932989 |doi= |url=}}</ref> | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
* May show decreased hemotocrit, leukocytosis and rarely, eosinophilia | |||
*May show decreased [[hemotocrit]], [[leukocytosis]] and rarely, [[eosinophilia]] | |||
Serum electrolytes | Serum electrolytes | ||
* Hyponatremia | |||
* Hyperkalemia | *[[Hyponatremia]] | ||
* Hypercalcemia | *[[Hyperkalemia]] | ||
Blood urea nitrogen | *[[Hypercalcemia]] | ||
* Elevated | |||
Creatinine | [[Blood urea nitrogen]] | ||
* Elevated | |||
Plasma glucose | *Elevated | ||
* Hypoglycemia | |||
Serum cortisol | [[Creatinine]] | ||
* Decreased | |||
Plasma ACTH | *Elevated | ||
* Elevated | |||
|CT | Plasma glucose | ||
* Shows adrenal enlargement or adrenal aymmetry | |||
*[[Hypoglycemia]] | |||
Serum [[cortisol]] | |||
*Decreased | |||
Plasma [[ACTH]] | |||
*Elevated | |||
|CT | |||
*Shows adrenal enlargement or adrenal aymmetry | |||
| | | | ||
* Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis | *Short cosyntropin (Cortrosyn) stimulation test confirms the diagnosis | ||
|- | |- | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ||
Line 1,727: | Line 2,169: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
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Tests are used to rule out other pathologies; | Tests are used to rule out other pathologies; | ||
CBC | CBC | ||
*May indicate anemia | |||
*May indicate [[anemia]] | |||
Blood cultures | Blood cultures | ||
*May be positive for various organisms | *May be positive for various organisms | ||
ESR and CRP | ESR and CRP | ||
*May be | |||
*May be elevated | |||
LDH | LDH | ||
*May be elevated | *May be elevated | ||
Cytogenetic studies | Cytogenetic studies | ||
* May be positive for t(11;22) translocation | |||
*May be positive for t(11;22) translocation | |||
Immunohistochemical markers | Immunohistochemical markers | ||
*May be positive for MIC2 antigen (CD99) | *May be positive for MIC2 antigen (CD99) | ||
|Radiography | |Radiography | ||
*Periosteal reaction "onion skin" | *Periosteal reaction "onion skin" | ||
*Cortical thinning | *Cortical thinning | ||
*Mottling | *Mottling | ||
MRI | MRI | ||
*Skip lesions | *Skip lesions | ||
*Edema | *Edema | ||
*Metastasis | *Metastasis | ||
PET - FDG | PET - FDG | ||
*To identify metastatic disease | *To identify metastatic disease | ||
| | | | ||
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|Tests used to rule out other pathologies; | |Tests used to rule out other pathologies; | ||
CBC | CBC | ||
*Reticulocyte count may be increased | |||
*Positive or negative direct and indirect Coombs test | *[[Reticulocyte]] count may be increased | ||
*Immunoglobulin levels may be elevated | *Positive or negative direct and indirect [[Coombs test]] | ||
*[[Immunoglobulin]] levels may be elevated | |||
ESR | ESR | ||
*May be elevated | *May be elevated | ||
LFT | LFT | ||
*May demonstrate elevations in total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase | |||
*Elevations may mean liver cirrhosis | *May demonstrate elevations in total [[protein]], [[albumin]], [[alanine aminotransferase]], [[aspartate aminotransferase]], [[alkaline phosphatase]], and gamma-glutamyltransferase | ||
*Elevations may mean [[liver cirrhosis]] | |||
Urine analysis | Urine analysis | ||
*Decrease in urine osmolality may indicate diabetes insipidus | |||
*Decrease in urine osmolality may indicate [[diabetes insipidus]] | |||
|Radiography | |Radiography | ||
*Single or multiple osteolytic lesions may be noted | *Single or multiple osteolytic lesions may be noted | ||
CT | CT | ||
*To identify abnormalities of the hypothalamic and/or pituitary region | *To identify abnormalities of the hypothalamic and/or pituitary region | ||
MRI | MRI | ||
*To identify abnormalities of the hypothalamic and/or pituitary region | *To identify abnormalities of the hypothalamic and/or pituitary region | ||
PET - FDG | PET - FDG | ||
*More sensitive than CT or MRI to active disease | *More sensitive than CT or MRI to active disease | ||
| | | | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Mature or immature leukocytosis | |||
*Mature or immature [[leukocytosis]] | |||
Coagulation study | Coagulation study | ||
*May demonstrate elevated prothrombin time, decreasing fibrinogen level, and presence of fibrin split products | |||
*May demonstrate elevated[[ prothrombin time]], decreasing [[fibrinogen]] level, and presence of fibrin split products | |||
Peripheral blood smear | Peripheral blood smear | ||
*May demonstrate blasts, | |||
*May demonstrate blasts, ppschistocyte]]s, auer rods, and mature [[lymphocytosis]] | |||
Blood chemistry profile | Blood chemistry profile | ||
*May demonstrate tumor lysis syndrome through elevated LDH and uric acid | |||
*May demonstrate [[tumor lysis syndrome]] through elevated [[LDH]] and [[uric acid]] | |||
Blood culture | Blood culture | ||
*To rule out infection | *To rule out infection | ||
| | | | ||
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|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Typically no specific lab findings, however, the following routine tests are performed; | |Typically no specific lab findings, however, the following routine tests are performed; | ||
*CBC | *CBC | ||
*Serum chemistry studies, including LDH | *Serum chemistry studies, including LDH | ||
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*HIV serology | *HIV serology | ||
|Radiography | |Radiography | ||
*May demonstrate hilar or mediastinal adenopathy | *May demonstrate hilar or mediastinal adenopathy | ||
*Pleural or pericardial effusion | *Pleural or [[pericardial effusion]] | ||
*Parenchymal involvement | *Parenchymal involvement | ||
*Bulky mediastinal mass | *Bulky mediastinal mass | ||
CT | CT | ||
*May demonstrate enlarged lymph nodes | *May demonstrate enlarged lymph nodes | ||
*Hepatosplenomegaly | *Hepatosplenomegaly | ||
*Filling defects in visceral organs | *Filling defects in visceral organs | ||
Bone scan | Bone scan | ||
*Useful in those with elevated alkaline phosphatase | |||
*Useful in those with elevated [[alkaline phosphatase]] | |||
Gallium scan | Gallium scan | ||
*May show increased uptake | *May show increased uptake | ||
MRI | MRI | ||
*Signal intensity changes are noted in those with bone marrow or muscular involvement | *Signal intensity changes are noted in those with bone marrow or muscular involvement | ||
PET - FDG | PET - FDG | ||
*To distinguish between viable, active tumors and necrosis | *To distinguish between viable, active tumors and necrosis | ||
*To detect early recurrence | *To detect early recurrence | ||
Ultrasound | Ultrasound | ||
*Useful if primary lesion is in testis | *Useful if primary lesion is in testis | ||
| | | | ||
*Hodgkin's lymphoma is usually focal and characterized by Reed-sternberg cells | *[[Hodgkin's lymphoma]] is usually focal and characterized by Reed-sternberg cells | ||
*Non - hodgkin's lymphoma tends to be multifocal | *[[Non - hodgkin's lymphoma]] tends to be multifocal | ||
*Biopsy provides ultimate diagnosis | *Biopsy provides ultimate diagnosis | ||
|- | |- | ||
![[ | ![[Multiple myeloma]]<ref name="pmid12528874">{{cite journal |vauthors=Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR |title=Review of 1027 patients with newly diagnosed multiple myeloma |journal=Mayo Clin. Proc. |volume=78 |issue=1 |pages=21–33 |date=January 2003 |pmid=12528874 |doi=10.4065/78.1.21 |url=}}</ref><ref name="pmid20194150">{{cite journal |vauthors=Turesson I, Velez R, Kristinsson SY, Landgren O |title=Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic |journal=Mayo Clin. Proc. |volume=85 |issue=3 |pages=225–30 |date=March 2010 |pmid=20194150 |pmc=2843108 |doi=10.4065/mcp.2009.0426 |url=}}</ref> | ||
|Chronic | |||
| | |Years | ||
| | |Dull aching | ||
| | |Hips, groin and legs | ||
| | | +/- | ||
| | | +/- | ||
| | | +/- | ||
| | | - | ||
| | | - | ||
| | | - | ||
| +/- | |||
| - | | - | ||
| - | | - | ||
| - | | - | ||
| - | | - | ||
| +/- | |||
| - | | - | ||
| | |Serum protein [[electrophoresis]] | ||
* | *May demonstrate a M peak | ||
Serum free light chain assay and 24 - hour urine collection | |||
* | *May detect Bence-Jones proteins | ||
* | |||
CRP | |||
* | |||
*May demonstrate | *May be elevated | ||
*May demonstrate | |||
* | Serum beta2-microglobulin | ||
PET | |||
* | *May be elevated | ||
Albumin | |||
*May demonstrate elevated [[albumin]] in urine | |||
LDH | |||
*May be elevated | |||
Peripheral blood smear | |||
*May demonstrate rouleaux formation > 50% | |||
*[[Leukopenia]] | |||
*[[Thrombocytopenia]] | |||
|Radiography, MRI and PET | |||
*Osteolytic lesions may be demonstrated | |||
| | | | ||
* | *Biopsy will demonstrate elevated plasma cells in the bone marrow | ||
|- | |- | ||
![[ | ![[Neurofibroma]]<ref name="pmid3582706">{{cite journal |vauthors=Banik R, Lubach D |title=Skin tags: localization and frequencies according to sex and age |journal=Dermatologica |volume=174 |issue=4 |pages=180–3 |date=1987 |pmid=3582706 |doi= |url=}}</ref> | ||
|Chronic<ref name="pmid17338704">{{cite journal |vauthors=Campbell LB, Petrick MG |title=Mohs micrographic surgery for a problematic infantile digital fibroma |journal=Dermatol Surg |volume=33 |issue=3 |pages=385–7 |date=March 2007 |pmid=17338704 |doi=10.1111/j.1524-4725.2007.33080.x |url=}}</ref><ref name="pmid8176009">{{cite journal |vauthors=Requena L, Fariña MC, Fuente C, Piqué E, Olivares M, Martín L, Sánchez Yus E |title=Giant dermatofibroma. A little-known clinical variant of dermatofibroma |journal=J. Am. Acad. Dermatol. |volume=30 |issue=5 Pt 1 |pages=714–8 |date=May 1994 |pmid=8176009 |doi= |url=}}</ref> | |||
|Weeks to years | |Weeks to years | ||
| | |Aching, pressure | ||
|Variable | |Variable | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| - | |||
| - | |||
| - | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | - | ||
| | | - | ||
* | |Molecular sequencing | ||
*Used to detect neurofibromin gene | |||
Urine analysis | |||
*Used to detect free [[catecholamine]] and their metabolites in suspected [[pheochromocytoma]] | |||
|Radiography | |Radiography | ||
* | *Bowing of bones | ||
* | *Medullary destruction | ||
* | |||
MRI and CT | |||
*May demonstrate | |||
*Used to determine neurologic pathologies | |||
*May demonstrate unidentified bright objects in brain scans | |||
*May demonstrate [[optic nerve]] and [[optic chiasma]] involvement | |||
* | *Bilateral [[acoustic neuroma]] is noted in [[neurofibromatosis]] type 2 | ||
PET - FDG | |||
*Used to determine staging | |||
| | | | ||
* | *Marfanoid habitus may be noted in [[neurfibromatosis]] type 1 | ||
|- | |- | ||
![[ | ![[Osteoblastoma]]<ref name="pmid8692589">{{cite journal |vauthors=Copley L, Dormans JP |title=Benign pediatric bone tumors. Evaluation and treatment |journal=Pediatr. Clin. North Am. |volume=43 |issue=4 |pages=949–66 |date=August 1996 |pmid=8692589 |doi= |url=}}</ref><ref name="pmid8272884">{{cite journal |vauthors=Greenspan A |title=Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations |journal=Skeletal Radiol. |volume=22 |issue=7 |pages=485–500 |date=October 1993 |pmid=8272884 |doi= |url=}}</ref><ref name="pmid1563167">{{cite journal |vauthors=Boriani S, Capanna R, Donati D, Levine A, Picci P, Savini R |title=Osteoblastoma of the spine |journal=Clin. Orthop. Relat. Res. |volume= |issue=278 |pages=37–45 |date=May 1992 |pmid=1563167 |doi= |url=}}</ref> | ||
|Chronic | |Chronic | ||
| | |Weeks to years | ||
| | |Dul aching | ||
|Variable | |Variable | ||
| - | |||
| - | |||
| - | | - | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| - | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
Line 1,994: | Line 2,517: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | | | ||
*Typically no specific lab findings are noted | |||
* | |||
|Radiography | |Radiography | ||
*May demonstrate | |||
*May demonstrate a well-circumscribed radiolucent tumor in cortex | |||
* | *Thin shell of peripheral new bone distinct from soft tissue | ||
*> 2cm in diameter | |||
* | *No associated reactive zone | ||
*Demonstrates | CT and MRI | ||
*May demonstrate size and extent of tumor relative to surrounding soft tissue | |||
*Demonstrates | |||
Bone scan | |||
*Demonstrates cortical activity within the bone | |||
Angiography | |||
*Demonstrates the vascularity of the tumor | |||
| | | | ||
*Pain is relieved by | *Presents in third decade of life | ||
*Pain is not relieved by NSAIDs | |||
|- | |- | ||
![[ | ![[Osteoid osteoma]]<ref name="pmid850593">{{cite journal |vauthors=Orlowski JP, Mercer RD |title=Osteoid osteoma in children and young adults |journal=Pediatrics |volume=59 |issue=4 |pages=526–32 |date=April 1977 |pmid=850593 |doi= |url=}}</ref><ref name="pmid20225104">{{cite journal |vauthors=Wyers MR |title=Evaluation of pediatric bone lesions |journal=Pediatr Radiol |volume=40 |issue=4 |pages=468–73 |date=April 2010 |pmid=20225104 |doi=10.1007/s00247-010-1547-4 |url=}}</ref><ref name="pmid8692589">{{cite journal |vauthors=Copley L, Dormans JP |title=Benign pediatric bone tumors. Evaluation and treatment |journal=Pediatr. Clin. North Am. |volume=43 |issue=4 |pages=949–66 |date=August 1996 |pmid=8692589 |doi= |url=}}</ref> | ||
|Chronic | |Chronic | ||
| | |Years | ||
| | |Dull aching | ||
|Variable | |Variable | ||
| - | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |||
|Serum chemistry study | |||
* | |||
* | *High levels of [[prostaglandin]] metabolites have been linked with [[osteoid osteoma]]s | ||
|Radiography | |||
*May demonstrate sclerosis around a radiolucent nidus | |||
CT | CT | ||
* | *Demonstrates the margins of the nidus and calcifications present | ||
MRI | MRI | ||
*Useful in | |||
*Useful only in a non-calcified nidus | |||
* | |||
* | Radionuclide scan | ||
| | |||
* | *Demonstrates increased uptake in diseased bone | ||
Arteriography | |||
*Used a last resort when other imaging has been unfruitful | |||
*Demonstrates 2 phases, early arterial phase, late arterial phase and venous phase | |||
| | |||
*Pain is relieved by use of NSAIDs | |||
|- | |- | ||
![[ | ![[Osteosarcoma]]<ref name="pmid16015627">{{cite journal |vauthors=Mialou V, Philip T, Kalifa C, Perol D, Gentet JC, Marec-Berard P, Pacquement H, Chastagner P, Defaschelles AS, Hartmann O |title=Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience |journal=Cancer |volume=104 |issue=5 |pages=1100–9 |date=September 2005 |pmid=16015627 |doi=10.1002/cncr.21263 |url=}}</ref><ref name="pmid1070715">{{cite journal |vauthors=Sissons HA |title=The WHO classification of bone tumors |journal=Recent Results Cancer Res. |volume= |issue=54 |pages=104–8 |date=1976 |pmid=1070715 |doi= |url=}}</ref><ref name="pmid13307660">{{cite journal |vauthors=CADE S |title=Osteogenic sarcoma; a study based on 133 patients |journal=J R Coll Surg Edinb |volume=1 |issue=2 |pages=79–111 |date=December 1955 |pmid=13307660 |doi= |url=}}</ref><ref name="pmid203202">{{cite journal |vauthors=Dahlin DC, Unni KK |title=Osteosarcoma of bone and its important recognizable varieties |journal=Am. J. Surg. Pathol. |volume=1 |issue=1 |pages=61–72 |date=March 1977 |pmid=203202 |doi= |url=}}</ref> | ||
|Chronic | |Chronic | ||
| | |Weeks to years | ||
| | |Severe, sharp | ||
|Variable | |||
| | |<nowiki>-</nowiki> | ||
| | |||
| - | | - | ||
| - | | - | ||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| - | | - | ||
| - | | - | ||
| - | | - | ||
|<nowiki>-</nowiki> | |||
|<nowiki>-</nowiki> | |||
| - | | - | ||
| - | |<nowiki>-</nowiki> | ||
| | | | ||
| | *Typically no specific lab findings | ||
*Elevated [[LDH]] and [[alkaline phosphatase]] may suggest pulmonary metastasis | |||
*May demonstrate | | | ||
Radiography | |||
* | |||
*May demonstrate an osteolytic or osteoblastic lesion | |||
*Elevation of the periosteum may be noted, and is known as "Codman's triangle" | |||
*Tumor spread to periosteum is known as "sunburst" sign | |||
* | |||
CT | |||
*May demonstrate | |||
*Chest CT is done to rule out pulmonary involvement | |||
* | *May also demonstrate the margins and extent of tumor | ||
MRI | |||
* | *Useful in detection of soft tissue involvement | ||
* | Bone scan | ||
*Increased uptake is noted in regions of metastasis | |||
*Technetium-99 - methylene diphosphonate is usually used | |||
| | | | ||
* | *Cardiac function should be assessed before the use of doxorubicin or daunorubicin | ||
|- | |- | ||
![[Prostate cancer]]<ref name="pmid15960930">{{cite journal |vauthors=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |date=June 2005 |pmid=15960930 |doi= |url=}}</ref><ref name="pmid1372943">{{cite journal |vauthors=Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ |title=The effect of digital rectal examination on prostate-specific antigen levels |journal=JAMA |volume=267 |issue=16 |pages=2227–8 |date=1992 |pmid=1372943 |doi= |url=}}</ref> | ![[Prostate cancer]]<ref name="pmid15960930">{{cite journal |vauthors=Porta M, Fabregat X, Malats N, Guarner L, Carrato A, de Miguel A, Ruiz L, Jariod M, Costafreda S, Coll S, Alguacil J, Corominas JM, Solà R, Salas A, Real FX |title=Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage |journal=Clin Transl Oncol |volume=7 |issue=5 |pages=189–97 |date=June 2005 |pmid=15960930 |doi= |url=}}</ref><ref name="pmid1372943">{{cite journal |vauthors=Crawford ED, Schutz MJ, Clejan S, Drago J, Resnick MI, Chodak GW, Gomella LG, Austenfeld M, Stone NN, Miles BJ |title=The effect of digital rectal examination on prostate-specific antigen levels |journal=JAMA |volume=267 |issue=16 |pages=2227–8 |date=1992 |pmid=1372943 |doi= |url=}}</ref> | ||
Line 2,105: | Line 2,645: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| - | | +/- | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|PSA | |[[PSA]] | ||
*Detection is helpful in diagnosis, usually > 10 ng/ml | *Detection is helpful in diagnosis, usually > 10 ng/ml | ||
Acid and alkaline | |||
*Useful in detecting | Acid and [[alkaline phosphatase]] | ||
*Useful in detecting metastasis | |||
Serurm creatinine and LFT | Serurm creatinine and LFT | ||
*Useful in detecting metasstasis | *Useful in detecting metasstasis | ||
Urine analysis | Urine analysis | ||
*May detect hematuria or infection | |||
*May detect [[hematuria]] or infection | |||
|Ultrasound | |Ultrasound | ||
*Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity | *Transrectal biopsy transrectal ultrasound may demonstrate hypoechoicity | ||
MRI | MRI | ||
*May be used to guide biopsy | *May be used to guide biopsy | ||
| | | | ||
Line 2,135: | Line 2,684: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
Line 2,199: | Line 2,748: | ||
| | | | ||
MRI and ultrasound | MRI and ultrasound | ||
*May be utilized in non-resolution of muscle spasm to visualize the soft tissue | *May be utilized in non-resolution of muscle spasm to visualize the soft tissue | ||
| | | | ||
*Rest, bandaging and topical | *Rest, bandaging and topical [[analgesic]]s are often used to treat | ||
|- | |- | ||
!Pyriformis syndrome<ref name="pmid25574881">{{cite journal |vauthors=Cass SP |title=Piriformis syndrome: a cause of nondiscogenic sciatica |journal=Curr Sports Med Rep |volume=14 |issue=1 |pages=41–4 |date=January 2015 |pmid=25574881 |doi=10.1249/JSR.0000000000000110 |url=}}</ref><ref name="pmid23900507">{{cite journal |vauthors=Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J |title=Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome |journal=Surg Radiol Anat |volume=36 |issue=3 |pages=273–80 |date=April 2014 |pmid=23900507 |doi=10.1007/s00276-013-1180-7 |url=}}</ref> | !Pyriformis syndrome<ref name="pmid25574881">{{cite journal |vauthors=Cass SP |title=Piriformis syndrome: a cause of nondiscogenic sciatica |journal=Curr Sports Med Rep |volume=14 |issue=1 |pages=41–4 |date=January 2015 |pmid=25574881 |doi=10.1249/JSR.0000000000000110 |url=}}</ref><ref name="pmid23900507">{{cite journal |vauthors=Natsis K, Totlis T, Konstantinidis GA, Paraskevas G, Piagkou M, Koebke J |title=Anatomical variations between the sciatic nerve and the piriformis muscle: a contribution to surgical anatomy in piriformis syndrome |journal=Surg Radiol Anat |volume=36 |issue=3 |pages=273–80 |date=April 2014 |pmid=23900507 |doi=10.1007/s00276-013-1180-7 |url=}}</ref> | ||
Line 2,225: | Line 2,775: | ||
| | | | ||
MRI and ultrasound | MRI and ultrasound | ||
*May be utilized in non-resolution of muscle spasm to visualize the soft tissue | *May be utilized in non-resolution of muscle spasm to visualize the soft tissue | ||
| | | | ||
*Rest, bandaging and topical | *Rest, bandaging and topical [[analgesic]]s are often used to treat | ||
|- | |- | ||
! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ! rowspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" |Classification of pain in the back based on etiology | ||
Line 2,242: | Line 2,793: | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Onset | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Duration | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Quality of pain | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Radiation | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ! align="center" style="background:#4479BA; color: #FFFFFF;" |Stiffness | ||
Line 2,279: | Line 2,830: | ||
| | | | ||
*Typically no specific lab findings, however, serology may be somewhat specific and demonstrate; | *Typically no specific lab findings, however, serology may be somewhat specific and demonstrate; | ||
**Elevated IgM and/or IgG in | **Elevated IgM and/or IgG in [[coxsackie virus]] B titer | ||
**Elevated IgM and/or IgG human | **Elevated IgM and/or IgG [[human herpes virus]] 6 titer | ||
**Elevated IgM/IgG in C pneumoniae titer | **Elevated IgM/IgG in C pneumoniae titer | ||
**Decrease in natural killer cell percentage or activity | **Decrease in [[natural killer cell]] percentage or activity | ||
*Labs used to exclude other pathologies include; | *Labs used to exclude other pathologies include; | ||
CBC | CBC | ||
*May demonstrate leukopenia or leukocytosis | |||
*May demonstrate [[leukopenia]] or [[leukocytosis]] | |||
LFT | LFT | ||
*May demonstrate elevated serum transaminases, alkaline phosphatase, or lactic dehydrogenase | |||
*May demonstrate elevated serum transaminases, [[alkaline phosphatase]], or [[lactic dehydrogenase]] | |||
TFT | TFT | ||
*To rule out hypo/hyperthyroidism | |||
*To rule out hypo/[[hyperthyroidism]] | |||
ESR | ESR | ||
*Usually low | *Usually low | ||
Serum electrolytes | Serum electrolytes | ||
*Hypokalemia or hypocalcemia may be noted | |||
ANA | *[[Hypokalemia]] or [[hypocalcemia]] may be noted | ||
[[ANA]] | |||
*May indicate an autoimmune disease | *May indicate an autoimmune disease | ||
Cortisol | |||
*May indicate pathology of the adrenal gland | [[Cortisol]] | ||
Serum protein electrophoresis | |||
*To rule out myeloma or lymphoma | *May indicate pathology of the [[adrenal gland]] | ||
Serum protein [[electrophoresis]] | |||
*To rule out myeloma or [[lymphoma]] | |||
|CT and MRI | |CT and MRI | ||
*Used to exclude other pathologies | *Used to exclude other pathologies | ||
PET | PET | ||
*May demonstrate hypoperfusion of the frontoparietal and/or temporal region of the brain | |||
*May demonstrate hypoperfusion of the frontoparietal and/or temporal region of the brain | |||
| | | | ||
*Usually diagnosed by exclusion | *Usually diagnosed by exclusion | ||
Line 2,328: | Line 2,898: | ||
*Typically no specific lab findings | *Typically no specific lab findings | ||
*Lab testing is used to diagnose organic causes and include; | *Lab testing is used to diagnose organic causes and include; | ||
**CBC | **[[CBC]] | ||
**TFT | **TFT | ||
**Vitamin B-12 detection | **Vitamin B-12 detection | ||
**Rapid plasma reagin | **[[Rapid plasma reagin]] | ||
**HIV testing | **[[HIV]] testing | ||
**Electrolytes, especially calcium, phosphate, and magnesium levels | **[[Electrolytes]], especially [[calcium]], [[phosphate]], and [[magnesium]] levels | ||
**BUN and creatinine | **[[BUN]] and [[creatinine]] | ||
** | **[[LFT]]s | ||
**Blood alcohol level | **Blood [[alcohol]] level | ||
**Blood and urine toxicology screen | **Blood and urine toxicology screen | ||
**ABG | **[[ABG]] | ||
**Dexamethasone suppression test | **[[Dexamethasone]] suppression test | ||
**Cosyntropin stimulation test | **Cosyntropin stimulation test | ||
|CT and MRI | |CT and MRI | ||
*To rule out organic brain syndrome or | |||
*To rule out organic brain syndrome or [[hypopituitarism]] | |||
PET | PET | ||
*Allows for study of ligand-receptor binding | *Allows for study of ligand-receptor binding | ||
SPECT | SPECT | ||
*May demonstrate regional blood flow deficits in the left anterofrontal and temporal regions | *May demonstrate regional blood flow deficits in the left anterofrontal and temporal regions | ||
| | | | ||
Line 2,372: | Line 2,947: | ||
*Lab tests are done to rule out organic causes, and include; | *Lab tests are done to rule out organic causes, and include; | ||
**CBC | **CBC | ||
***Infection (leukocytosis) or malignancy | ***Infection ([[leukocytosis]]) or malignancy | ||
**STD panel | **STD panel | ||
***Gonorrhea, chlamydia, and PID | ***[[Gonorrhea]], [[chlamydia]], and [[PID]] | ||
**Beta - Human chorionic gonadotropin | **Beta - Human chorionic gonadotropin | ||
***Elevated in pregnancy | ***Elevated in [[pregnancy]] | ||
**ESR | **ESR | ||
**Elevated in subacute salpingitis | **Elevated in subacute [[salpingitis]] | ||
**Urine analysis | **Urine analysis | ||
**To rule out urinary tract infection | **To rule out [[urinary tract infection]] | ||
**Stool guaiac test | **Stool guaiac test | ||
***To rule out | ***To rule out gastrointestinal bleeding | ||
|Ultrasound | |Ultrasound | ||
*May reveal endometriosis as complex mass with specks | |||
*Ectopic pregnancy | *May reveal [[endometriosis]] as complex mass with specks | ||
*[[Ectopic pregnancy]] | |||
*Ovarian cysts | *Ovarian cysts | ||
* | *[[Fibroid]]s | ||
*Intrauterine contraceptive device | *Intrauterine contraceptive device | ||
Hysterosalpingography | Hysterosalpingography | ||
*May demonstrate endometrial | |||
* | *May demonstrate [[endometrial polyp]]s | ||
*[[Leiomyoma]]s | |||
*Congenital abnormalities of the uterus | *Congenital abnormalities of the uterus | ||
IVP | IVP | ||
*May demonstrate a uterine malformation | |||
*May demonstrate a uterine malformation | |||
CT | CT | ||
*May demonstrate ovarian torsion | |||
*May demonstrate [[ovarian torsion]] | |||
MRI | MRI | ||
*May detect adenomyosis | |||
*May detect [[adenomyosis]] | |||
*Submucous myomas | *Submucous myomas | ||
| | | | ||
*Laparoscopy, hysteroscopy, and dilatation and curettage are useful in diagnosis and therapy | *[[Laparoscopy]], [[hysteroscopy]], and dilatation and curettage are useful in diagnosis and therapy | ||
|- | |- | ||
![[Herpes zoster]]<ref name="pmid17143845">{{cite journal |vauthors=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ |title=Recommendations for the management of herpes zoster |journal=Clin. Infect. Dis. |volume=44 Suppl 1 |issue= |pages=S1–26 |date=January 2007 |pmid=17143845 |doi=10.1086/510206 |url=}}</ref><ref name="pmid15897984">{{cite journal |vauthors=Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF |title=Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002 |journal=J. Infect. Dis. |volume=191 |issue=12 |pages=2002–7 |date=June 2005 |pmid=15897984 |doi=10.1086/430325 |url=}}</ref><ref name="pmid8637540">{{cite journal |vauthors=Kost RG, Straus SE |title=Postherpetic neuralgia--pathogenesis, treatment, and prevention |journal=N. Engl. J. Med. |volume=335 |issue=1 |pages=32–42 |date=July 1996 |pmid=8637540 |doi=10.1056/NEJM199607043350107 |url=}}</ref> | ![[Herpes zoster]]<ref name="pmid17143845">{{cite journal |vauthors=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, Betts RF, Gershon AA, Haanpaa ML, McKendrick MW, Nurmikko TJ, Oaklander AL, Oxman MN, Pavan-Langston D, Petersen KL, Rowbotham MC, Schmader KE, Stacey BR, Tyring SK, van Wijck AJ, Wallace MS, Wassilew SW, Whitley RJ |title=Recommendations for the management of herpes zoster |journal=Clin. Infect. Dis. |volume=44 Suppl 1 |issue= |pages=S1–26 |date=January 2007 |pmid=17143845 |doi=10.1086/510206 |url=}}</ref><ref name="pmid15897984">{{cite journal |vauthors=Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF |title=Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002 |journal=J. Infect. Dis. |volume=191 |issue=12 |pages=2002–7 |date=June 2005 |pmid=15897984 |doi=10.1086/430325 |url=}}</ref><ref name="pmid8637540">{{cite journal |vauthors=Kost RG, Straus SE |title=Postherpetic neuralgia--pathogenesis, treatment, and prevention |journal=N. Engl. J. Med. |volume=335 |issue=1 |pages=32–42 |date=July 1996 |pmid=8637540 |doi=10.1056/NEJM199607043350107 |url=}}</ref> | ||
Line 2,421: | Line 3,005: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Tzanck smear | |[[Tzanck smear]] | ||
*May demonstrate multinucleated giant cells | *May demonstrate multinucleated giant cells | ||
Direct fluorescent antibody test and/or PCR | |||
*Allows for differentiation between HSV and VZV | Direct fluorescent antibody test and/or [[PCR]] | ||
*Allows for differentiation between HSV and VZV | |||
| | | | ||
*Typically no routine imaging | *Typically no routine imaging | ||
MRI | MRI | ||
*Used to exclude myelopathy or encephalopathy | |||
Lumbar puncture and cerebrospinal fluid analysis | *Used to exclude [[myelopathy]] or [[encephalopathy]] | ||
*In cases of suspected meningitis, increased protein and pleocytosis will be noted | |||
[[Lumbar puncture]] and [[cerebrospinal fluid]] analysis | |||
*In cases of suspected [[meningitis]], increased [[protein]] and [[pleocytosis]] will be noted | |||
| | | | ||
|- | |- | ||
Line 2,452: | Line 3,042: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|Beta - human chorionic gonadotropin | |Beta - human chorionic gonadotropin | ||
*If detected usually confirms pregnancy | |||
*If detected usually confirms [[pregnancy]] | |||
| | | | ||
*Typically no routine imaging is done to prevent radiation exposure, unless complication occurs an MRI may be carried out | *Typically no routine imaging is done to prevent radiation exposure, unless complication occurs an MRI may be carried out | ||
Line 2,476: | Line 3,067: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*Hemoglobin level is between 5-9 g/dl | |||
*Hematocrit is decreased to 17-29% | *[[Hemoglobin]] level is between 5-9 g/dl | ||
*Leukocytosis with predominance of neutrophils | *[[Hematocrit]] is decreased to 17-29% | ||
*Thrombocytopenia | *[[Leukocytosis]] with predominance of [[neutrophils]] | ||
*[[Thrombocytopenia]] | |||
ESR | ESR | ||
*Decreased | *Decreased | ||
Reticulocyte count | Reticulocyte count | ||
*Elevated | *Elevated | ||
Peripheral blood smear | Peripheral blood smear | ||
*May demonstrate target | |||
*May demonstrate [[target cell]]s, elongated cells, and sickle erythrocytes | |||
*Howell - Jolly bodies in an asplenic patient | *Howell - Jolly bodies in an asplenic patient | ||
Hemoglobin solubility | |||
*Distinguishes between sickle cell disease and sickle cell trait | [[Hemoglobin]] solubility | ||
*Distinguishes between [[sickle cell disease]] and [[sickle cell trait]] | |||
Hemoglobin F | Hemoglobin F | ||
*Percentage of Hemoglobin F is elevated | |||
LFT, renal function test and pulmonary function test | *Percentage of [[Hemoglobin F]] is elevated | ||
LFT, [[renal function test]] and [[pulmonary function test]] | |||
*To assess organ distress or failure | *To assess organ distress or failure | ||
ABG | ABG | ||
*To detect oxygen saturation | |||
*To detect [[oxygen saturation]] | |||
Urine analysis | Urine analysis | ||
*May determine an urinary tract infection with hematuria and isosthenuria | |||
*May determine an [[urinary tract infection]] with hematuria and isosthenuria | |||
Sickling test | Sickling test | ||
*As screening for sickle hemoglobinopathies | *As screening for sickle hemoglobinopathies | ||
Secretory phospholipase A2 | Secretory phospholipase A2 | ||
*May be increased in acute chest syndrome, a complication of sickle cell disease | |||
*May be increased in acute chest syndrome, a complication of [[sickle cell disease]] | |||
|Radiography | |Radiography | ||
*Osteonecrosis | *Osteonecrosis | ||
*Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency | *Dactylitis indicated by medullary expansion, cortical thinning, trabecular resorption, and bone lucency | ||
*Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation | *Osteomyelitis may be present and demonstrate sequestra, cortical destruction, periosteal growth and sinus formation | ||
MRI and CT | MRI and CT | ||
*In addition to findings in radiography, may detect bone marrow hyperplasia | |||
*May also be useful in ruling out renal medullary carcinoma in those presenting with hematuria | *In addition to findings in radiography, may detect [[bone marrow hyperplasia]] | ||
*May also be useful in ruling out renal medullary carcinoma in those presenting with [[hematuria]] | |||
Nuclear imaging | Nuclear imaging | ||
*Used to detect early osteonecrosis through Technetium-99m bone scanning | *Used to detect early osteonecrosis through Technetium-99m bone scanning | ||
*Used to detect early osteomyelitis through detection of elevation of white blood | *Used to detect early [[osteomyelitis]] through detection of elevation of[[white blood cell]]s in Indium-11 white blood cell scanning | ||
Transcranial doppler ultrasonography | Transcranial doppler ultrasonography | ||
*Abnormally high blood flow is detected in those at increased risk of stroke | |||
*Abnormally high blood flow is detected in those at increased risk of [[stroke]] | |||
Abdominal ultrasound | Abdominal ultrasound | ||
*Used to exclude other pathologies such as, cholecystitis, cholelithiasis, ectopic pregnancy, nephrolithiasis, and papillary necrosis | |||
*Used to exclude other pathologies such as, [[cholecystitis]], [[cholelithiasis]], [[ectopic pregnancy]], [[nephrolithiasis]], and [[papillary necrosis]] | |||
*May also be used to asses the size of the liver and spleen | *May also be used to asses the size of the liver and spleen | ||
Echocardiography | Echocardiography | ||
*Used to diagnose pulmonary hypertension based on tricuspid regurgitant jet velocity | |||
*Used to diagnose [[pulmonary hypertension]] based on tricuspid regurgitant jet velocity | |||
*Also used to assess abnormalities of systolic and diastolic function | *Also used to assess abnormalities of systolic and diastolic function | ||
| | | | ||
*Sickle cell trait confers some protection against malaria | *Sickle cell trait confers some protection against [[malaria]] | ||
|- | |- | ||
![[Syringomyelia]]<ref name="pmid16676921">{{cite journal |vauthors=Milhorat TH |title=Classification of syringomyelia |journal=Neurosurg Focus |volume=8 |issue=3 |pages=E1 |date=March 2000 |pmid=16676921 |doi=10.3171/foc.2000.8.3.1 |url=}}</ref><ref name="pmid16549414">{{cite journal |vauthors=Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA |title=Ethnic differences in syringomyelia in New Zealand |journal=J. Neurol. Neurosurg. Psychiatry |volume=77 |issue=8 |pages=989–91 |date=August 2006 |pmid=16549414 |pmc=2077633 |doi=10.1136/jnnp.2005.081240 |url=}}</ref><ref name="pmid11807404">{{cite journal |vauthors=Larner AJ, Muqit MM, Glickman S |title=Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature |journal=Medicine (Baltimore) |volume=81 |issue=1 |pages=41–50 |date=January 2002 |pmid=11807404 |doi= |url=}}</ref> | ![[Syringomyelia]]<ref name="pmid16676921">{{cite journal |vauthors=Milhorat TH |title=Classification of syringomyelia |journal=Neurosurg Focus |volume=8 |issue=3 |pages=E1 |date=March 2000 |pmid=16676921 |doi=10.3171/foc.2000.8.3.1 |url=}}</ref><ref name="pmid16549414">{{cite journal |vauthors=Brickell KL, Anderson NE, Charleston AJ, Hope JK, Bok AP, Barber PA |title=Ethnic differences in syringomyelia in New Zealand |journal=J. Neurol. Neurosurg. Psychiatry |volume=77 |issue=8 |pages=989–91 |date=August 2006 |pmid=16549414 |pmc=2077633 |doi=10.1136/jnnp.2005.081240 |url=}}</ref><ref name="pmid11807404">{{cite journal |vauthors=Larner AJ, Muqit MM, Glickman S |title=Concurrent syrinx and inflammatory central nervous system disease detected by magnetic resonance imaging: an illustrative case and review of the literature |journal=Medicine (Baltimore) |volume=81 |issue=1 |pages=41–50 |date=January 2002 |pmid=11807404 |doi= |url=}}</ref> | ||
Line 2,542: | Line 3,165: | ||
|*Typically no specific lab findings | |*Typically no specific lab findings | ||
|MRI | |MRI | ||
*Of choice and demonstrates a syrinx (spinal cord cyst) | *Of choice and demonstrates a syrinx (spinal cord cyst) | ||
*May also be useful in assessment of CSF flow dynamics | *May also be useful in assessment of CSF flow dynamics | ||
Radiography and CT | Radiography and CT | ||
*May also visualize a syrinx | *May also visualize a syrinx | ||
Gadolinium scan | Gadolinium scan | ||
*Useful in assessment of post-operative patients and can distinguish between a tumor, scar, and disk material | |||
*Useful in assessment of post-operative patients and can distinguish between a [[tumor]], [[scar]], and disk material | |||
Myelography | Myelography | ||
*Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block | |||
*Used when MRI is unfruitful, and may detect widening of spinal cord and complete subarachnoid block | |||
| | | | ||
|- | |- | ||
Line 2,572: | Line 3,202: | ||
|After establishment of first aid protocol, the following lab tests may be useful; | |After establishment of first aid protocol, the following lab tests may be useful; | ||
Pregnancy test | Pregnancy test | ||
*In women of child-bearing age | *In women of child-bearing age | ||
Blood typing, screening and cross matching | Blood typing, screening and cross matching | ||
*In case of blood transfusion | |||
*In case of [[blood transfusion]] | |||
Prothrombin time | Prothrombin time | ||
*To assess those taking warfarin | |||
*To assess those taking [[warfarin]] | |||
Creatine kinase | Creatine kinase | ||
*To determine incidence of rhadomyolysis | |||
*To determine incidence of [[rhadomyolysis]] | |||
Blood sugar | Blood sugar | ||
*To determine hypoglycemia | |||
*To determine [[hypoglycemia]] | |||
Cardiac enzymes | Cardiac enzymes | ||
*To determine incidence of myocardial infarction | |||
*To determine incidence of [[myocardial infarction]] | |||
Toxicology screen and alcohol level | Toxicology screen and alcohol level | ||
*To determine alcoholism and drug use | *To determine alcoholism and drug use | ||
Serum lactate | Serum lactate | ||
*Elevated serum lactate may indicate a serious injury | |||
*Elevated serum [[lactate]] may indicate a serious injury | |||
|To assess trauma, the following imaging may be used; | |To assess trauma, the following imaging may be used; | ||
*Portable radiography | *Portable radiography | ||
*Ultrasound | *Ultrasound | ||
Line 2,614: | Line 3,260: | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|CBC | |CBC | ||
*To rule out anemia | |||
*To rule out [[anemia]] | |||
Coagulation profile | Coagulation profile | ||
*To rule out bleeding | *To rule out bleeding | ||
Electrolyte levels | |||
*To rule out nephrolithiasis | Electrolyte levels | ||
BUN and serum creatinine | |||
*To assess kidney function | *To rule out [[nephrolithiasis]] | ||
Urine culture | |||
*To rule out urinary tract infection | BUN and serum creatinine | ||
|Voiding cystourethrography | |||
*May demonstrate vesicoureteral reflux | *To assess kidney function | ||
*Ostruction usually shows hydronephrosis without reflux | |||
Renal ultrasonography | Urine culture | ||
*May determine kidney malformation and scarring | |||
*Dilation of collecting system | *To rule out [[urinary tract infection]] | ||
*Annular stricturing | |Voiding cystourethrography | ||
IVP | |||
*May demonstrate a hydronephrotic kidney | *May demonstrate [[vesicoureteral reflux]] | ||
*Used to map out entire urinary system | *Ostruction usually shows [[hydronephrosis]] without reflux | ||
CT and MRU | |||
*Provides detail about the urinary system such as; | Renal ultrasonography | ||
**Renal vasculature | |||
**Renal pelvis anatomy | *May determine kidney malformation and scarring | ||
**Location of crossing vessels | *Dilation of collecting system | ||
**Renal cortical scarring | *Annular stricturing | ||
**Ureteral fetal folds in the proximal ureter | |||
Doppler | IVP | ||
*Used to detect cross vessels associated with obstruction | |||
MRA | *May demonstrate a hydronephrotic kidney | ||
*May demonstrate aberrant renal vessels | *Used to map out entire urinary system | ||
| | |||
*Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction | CT and MRU | ||
|- | |||
|} | *Provides detail about the urinary system such as; | ||
</small></small> | **Renal vasculature | ||
**Renal pelvis anatomy | |||
==References== | **Location of crossing vessels | ||
{{Reflist|2}} | **Renal cortical scarring | ||
**Ureteral fetal folds in the proximal ureter | |||
Doppler | |||
*Used to detect cross vessels associated with obstruction | |||
MRA | |||
*May demonstrate aberrant renal vessels | |||
| | |||
*Congenital abrnormalities in both children and adults are usually the cause of UPJ obstruction | |||
|- | |||
|} | |||
</small></small> | |||
==References== | |||
{{Reflist|2}} | |||
{{WikiDoc Help Menu}} | |||
{{WikiDoc Sources}} | |||
[[Category:Pain]] | [[Category:Pain]] | ||
Line 2,658: | Line 3,326: | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 14:21, 18 May 2021
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
An expert algorithm to assist in the diagnosis of back pain can be found here
Overview
There are several life-threatening causes of back pain, including spinal cord or cauda equina compression, aortic dissection, aortic aneurysm, vertebral osteomyelitis, epidural abscess, and metastatic cancer. These should be evaluated alongside other possible causes of back pain by carefully assessing the nature of the pain, and obtaining a thorough patient history.
Differential Diagnosis of Back Pain
The following table outlines the major differential diagnoses of back pain.
To review the differential diagnosis of back pain and bowel or bladder dysfunction, click here.
To review the differential diagnosis of back pain, bowel or bladder dysfunction and horner's syndrome, click here.
To review the differential diagnosis of back pain and fever, click here.
To review the differential diagnosis of back pain, fever and stiffness, click here.
To review the differential diagnosis of back pain and heart murmur, click here.
To review the differential diagnosis of back pain and headache, click here.
To review the differential diagnosis of back pain and horner's syndrome, click here.
To review the differential diagnosis of back pain and motor weakness, click here.
To review the differential diagnosis of back pain, motor weakness and sensory deficit, click here.
To review the differential diagnosis of back pain and nausea and vomiting, click here.
To review the differential diagnosis of back pain and pulse deficit, click here.
To review the differential diagnosis of back pain and sensory deficit, click here.
To review the differential diagnosis of back pain and stiffness, click here.
To review the differential diagnosis of back pain and syncopy, click here.
To review the differential diagnosis of back pain and weight loss, click here.
To review the differential diagnosis of back pain exhibiting "red flags", click here.
Abbreviations: ABG = Arterial blood gases, ANA = Antinuclear antibodies, BUN = Blood urea nitrogen, CRP = C-reactive protein, CT = Computed tomography, DRA = Dual energy radiographic absorptiometry, DRE = Digital rectal exam, ERCP = Endoscopic retrograde cholangiopancreatography, ESR = Erythrocyte sedimentation rate, HSV = Herpes simplex virus, IVP = Intravenous pyelography, KUB = Kidney, bladder, ureter, LDH = Lactate dehydrogenase, LFT = Liver function test, MRA = Magnetic resonance angiography, MRC = Magnetic resonance cholangiopancreatography, MRI = Magnetic resonance imaging, MRU = Magnetic resonance urography, NSAIDs = Non-steroidal anti-inflammatory drugs, PCR = Polymerase chain reaction, PET - FDG = Positive emission tomography - fluorodeoxyglucose, PET = Positive emission tomography, PID = Pelvic inflammatory disease, PSA = Prostatic specific antigen, PTC = Percutaneous transhepatic cholangiography, RUQ = Right upper quadrant, SPECT = Single-photon emission computed tomography, TFT = Thyroid function test, VZV = Varicella zoster virus
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Vascular | Retroperitoneal hematoma[1][2][3] | Acute or subacute | Minutes to hours | Sharp and knife-like, also tearing or ripping | Back and/or flanks | - | - | - | - | +/- | - | - | - | - | - | - | - | - |
Typically no specific lab findings, however, evidence of hemorrhage and organ injury may be seen in:
|
CT with IV contrast
|
|
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Neurological | Arachnoiditis[4] | Acute | Hours | Dull aching pain | Head, neck and back | +/- | + | +/- | +/- | +/- | +/- | +/- | +/- | +/- | - | - | +/- | +/- | CSF
Culture and sensitivity
Nucleic acid tests
|
Radiography
|
|
Cauda equina syndrome[5][6] | Acute | Hours | Severe, sharp local pain | Rarely to sacroiliac joint | - | - | - | - | - | - | - | + | +/- | - | - | +/- | - | CBC
Electrolytes, blood urea nitrogen, and creatinine
Erythrocyte sedimentation rate
Syphilis serology
|
Radiography
MRI
Duplex
|
Electrical studies:
SSEPs
| |
Epidural abscess[7][8] | Acute | Variable | Dull, throbbing pain | Locally | - | +/- | +/- | +/- | +/- | +/- | +/- | +/- | +/- | - | - | +/- | +/- | CBC
ESR
Culture and sensitivity
Immunohistochemical staining
|
MRI
CT
Radiography
|
| |
Radiculopathy[9][10] | Acute | Variable | Severe, shooting pain | Anterior thigh and knee | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | - |
|
Radiography
CT
MRI
Myelography
Discography
|
| |
Sciatica[11][12][12] | Acute | Minutes to hours | Severe, shooting pain | Posterior thigh, buttocks and knee | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | - | To exclude other pathologies |
Radiography
CT
MRI
Myelography
Discography
|
| |
Spinal cord compression[5][6]
- Thoracic spine - Lumbar spine |
Acute | Minutes to hours | Severe and localized | Locally, may radiate below lesion | - | - | - | - | - | - | - | +/- | +/- | - | - |
+/- |
- | Neoplasm must be suspected and is ruled out by
|
MRI
Radiography
Nuclear imaging
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Bone | Ankylosing spondylitis[13][14] | Subacute or chronic | Years | Dull aching pain | Local | + | - | - | - | - | - | - | - | - | - | - | - | - |
|
MRI
CT
Radiography
Doppler ultrasound
|
Extra-articular manifestations are common and include
Often affecting a young male |
Bertolotti's syndrome[5] (Lumbosacral transitional vertebrae) | Chronic | Years | Dull aching pain | Local | - | - | - | - | - | - | - | - | - | - | - | - | - |
|
MRI
CT
Radiography
|
| |
Chronic recurrent focal osteomyelitis[15][16][17] | Chronic | Years | Dull aching pain | Local | +/- | + | + | - | - | - | +/- | - | - | - | - | - | - | CBC
Culture and sensitivity
|
Radiography
MRI
CT
Ultrasound
Nuclear imaging
|
| |
Cervical fracture[18][19] | Acute | Minutes to hours | Severe, sharp | Shoulder and arm | - | - | - | +/- | - | - | - | +/- | +/- | - | - | - | +/- |
|
Radiography
CT
MRI
|
| |
Degenerative disc disease[20][21] | Subacute or chronic | Years | Dull aching | Local | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | +/- | Serology
|
MRI
CT
Diskography
|
| |
Disc herniation[22][23] | Acute | Minutes to hours | Sharp,shooting | Legs and hips | - | - | - | - | - | - | - | +/- | +/- | - | - | +/- | - |
|
MRI
CT myelography
Radiography
Discography
|
| |
Discitis[24][25] | Chronic | Years | Dull aching or throbbing | Local | - | + | +/- | - | +/- | - | +/- | +/- | +/- | - | - | +/- | - | CBC
Culture and sensitivity
|
MRI
Radiography
Nuclear imaging
|
| |
Hyperkyphosis[26][27] | Chronic | Years | Dull aching | Local | +/- | - | - | - | - | - | - | +/- | +/- | - | - | - | - |
|
Radiography
|
| |
Osteoarthritis[28][29][30] | Chronic | Years | Dull aching | Local | + | - | - | - | - | - | - | - | - | - | - | - | - | ESR
CRP
Synovial fluid analysis
|
Radiography
MRI
|
| |
Sacroiliac joint dysfunction[31][32] | Chronic | Years | Dull aching | Hips and legs | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | - | CBC
ESR
CRP
Serology Metabolic panel
|
Imaging is controversial, however, CT may demonstrate;
MRI
Nuclear imaging
|
| |
Sacroilitis[32][33] | Acute or chronic | Variable | Dull aching or throbbing | Hips and legs | +/- | + | +/- | - | - | - | +/- | +/- | +/- | - | - | +/- | - | CBC
ESR
CRP
Procalcitonin
Culture and sensitivity
|
MRI
CT
Radiography
Nuclear imaging
|
| |
Scheuermann (juvenile) kyphosis[34][35] | Chronic | Years | Dull aching | Shoulders and arms | +/- | - | - | - | - | - | - | - | - | - | - | - | - |
|
Radiography
|
| |
Scoliosis[36][37][38] | Chronic | Years | Dull aching | Shoulders, arms, hips and legs | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | - |
|
Radiography
MRI
|
| |
Spinal stenosis[39][40] | Chronic | Years | Dull aching | Hips and legs | +/- | - | - | - | - | - | - | +/- | +/- | - | - | +/- | +/- |
|
MRI
CT
|
| |
Spondylosis[41][42] | Chronic[43] | Years | Dull aching | Shoulders, arms, hips and legs | +/- | - | - | +/- | - | - | - | +/- | +/- | - | - | +/- | +/- |
|
Radiography
MRI
CT myelography
|
| |
Vertebral compression fracture[44][45][46] | Acute | Minutes to hours | Sudden, severe, sharp | Shoulders, arms, hips and legs | +/- | - | - | +/- | +/- | +/- | - | +/- | +/- | - | - | +/- | - | CBC
Urine analysis
Serum protein electrophoresis
ESR
|
Radiography
CT
MRI
DRA scanning
PET scanning
|
| |
Vertebral osteomyelitis[47][48][49] | Acute | Minutes to hours | Sudden, severe, sharp | Shoulders, arms, hips and legs | +/- | + | +/- | - | +/- | - | - | +/- | +/- | - | - | +/- | - | CBC
ESR
CRP
Procalcitonin
Culture and sensitivity
|
Radiography
MRI
CT
Ultrasound
Nuclear imaging
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Referred pain | Aortic aneurysm
rupture[50][51][52] - Abdominal aortic aneurysm |
Acute | Minutes to hours | Sharp and knife-like, also tearing or ripping | Back and/ or flanks | - | - | - | - | - | +/- | - | - | - | + | +/- | - | - | Typically no specific lab findings, however, evidence of haemorrhage and organ injury may be seen in:
|
Ultrasonography
Chest radiography
CT
MRI
Echocardiography (Transesophageal)
|
|
Aortic dissection[53][54][55][55][56][57] | Severe and sudden (acute) and rarely, chronic | Minutes to hours | Sharp and knife-like, also tearing or ripping | Back and/or flanks | - | - | - | - | - | +/- | - | - | - | + | +/- | - | - | Elevations in:
|
ECG:
Chest radiography:
|
| |
Appendicitis[58][59][60] | Acute | Minutes to hours | Burning | Umbilicus and lower right quadrant | - | + | +/- | - | + | - | - | - | - | - | - | - | - | CBC
CRP
Urine analysis
Urine 5-HIAA
|
Ultrasound
CT
MRI
KUB Radiography
Radionuclide scanning
|
||
Cholelithiasis[61][62] | Acute or subacute | Minutes or hours | Sharp | Tip of right shoulder | - | +/- | +/- | - | + | - | +/- | - | - | - | - | - | - | CBC
LFT
|
Radiography
CT
MRI
Ultrasound
Scintigraphy
ERCP
PTC
|
| |
Chronic stable angina[63][64] | Chronic | Variable | Discomfort in the chest | Left shoulder, arm and jaw | - | - | - | - | +/- | +/- | - | - | - | +/- | - | - | - | Detection of:
|
Chest radiography
Exercise stress testing
Stress Echo
Nuclear imaging
CT
CT Angiography
EKG
|
| |
Cystitis[65][66][67] | Acute | Hours | Burning | Suprapubic | - | +/- | +/- | - | - | - | - | - | - | - | - | +/- | - | Urine analysis
Urine culture
CBC
|
|
| |
Endocarditis[68][69][70] | Acute or subacute | Variable | Discomfort in the chest | Jaw and arms | - | +/- | +/- | - | +/- | +/- | - | - | - | +/- | + | - | - | CBC
Serology
ESR
Urine analysis
Blood culture
|
Echocardiography
Radiography
Ultrasound
|
| |
Myalgia[71][72][73] | Chronic | Years | Dull aching | Variable | +/- | +/- | +/- | +/- | - | - | - | - | - | - | - | - | - | *Typically no specific lab findings
Rheumatoid factor and/or anti-cyclic citrullinated peptide antibodies
CRP and ESR
CBC
Bone profile
|
|
| |
Nephrolithiasis[74][75][76] | Acute | Hours | Severe, sharp | Abdomen, hips, groin, legs | - | +/- | +/- | - | +/- | - | - | - | - | - | - | - | - | CBC
Electrolytes
Creatinine
Uric acid
ABG
|
CT
IVP
KUB radiography
Ultrasound
Plain renal tomography
Retrograde pyelography
Nuclear renal imaging
|
| |
Pancreatitis[77][78][79] | Acute or chronic | Variable | Severe, sharp or dull aching | Abdomen | - | +/- | +/- | - | + | +/- | +/- | - | - | - | - | - | - | Amylase and lipase
LFT
CBC
Serum electrolytes
BUN and creatinine
Triglycerides
|
KUB radiography
Ultrasound
CT
MRC
ERCP
|
| |
Pelvic inflammatory disease[80][81][82] | Acute or chronic | Variable | Dullaching or throbbing | Hips, groin, legs | - | +/- | +/- | - | +/- | - | - | - | - | - | - | - | - | CBC
Pregnancy test
STD panel
Urine analysis
|
Transvaginal ultrasound
Laparoscopy
MRI and CT
|
| |
Pulmonary embolism[83][84][85] | Acute | Minutes | Severe, sharp | Chest and back | - | - | - | +/- | +/- | +/- | - | - | - | +/- | +/- | - | - | Lab findings are not specfic and are done to rule out other diseases such as:
|
|
| |
Pyelonephritis[86] | Acute or chronic | Variable | Severe, sharp or dull aching | Groin, hips and legs | - | + | +/- | - | +/- | - | - | - | - | - | - | +/- | - | CRP
ESR
Urinalysis
|
Ultrasound
Non-contrast CT
MRI
|
| |
Pneumonia[87][88][89] | Acute or chronic | Variable | Variable | Chest, back and abdomen | - | + | + | +/- | +/- | +/- | +/- | - | - | - | - | - | - | CBC
Blood culture
|
Radiography
CT
|
| |
Pyomyositis[90][91][92][93] | Acute or chronic | Days to weeks | Dull aching or throbbing | Variable | - | + | +/- | - | - | - | - | - | - | - | - | - | - | CBC
ESR
Serum creatine kinase and aldolase
Blood culture
Culture and sensitivity
|
MRI
CT
Ultrasound
Gallium scan
|
| |
Rheumatoid arthritis[94][95][96] | Chronic | Years | Severe, aching | Variable | + | - | - | - | - | - | +/- | - | - | - | - | - | - | ESR and CRP
CBC
ANA
Anti−cyclic citrullinated peptide (anti-CCP) and anti−mutated citrullinated vimentin (anti-MCV)
|
Radiography
MRI
Ultrasound
|
| |
Traumatic aortic rupture[97][98] | Acute | Minutes to hours | Sharp and knife-like, also tearing or ripping | Back and/ or flanks | - | - | - | - | - | +/- | - | - | - | +/- | +/- | - | - | Typically no specific lab findings, however, evidence of hemorrhage and organ injury may be seen in:
|
Ultrasonography
CT
MRI
Angiography
Echocardiography (Transesophageal)
|
| |
Waterhouse-Friderichsen syndrome[99][100] | Acute | Minutes to hours | Sudden, severe, sharp | Back and/or flanks | - | + | +/- | +/- | +/- | +/- | +/- | - | - | - | - | - | - | CBC
Serum electrolytes
Plasma glucose Serum cortisol
Plasma ACTH
|
CT
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Tumors | Ewing's sarcoma[101][102][103] | Chronic | Months to years | Dull aching | Variable | +/- | +/- | +/- | - | - | - | + | - | - | - | - | - | - |
Tests are used to rule out other pathologies; CBC
Blood cultures
ESR and CRP
LDH
Cytogenetic studies
Immunohistochemical markers
|
Radiography
MRI
PET - FDG
|
|
Langerhans cell histiocytosis[104][105][106][106](eosinophilic granulomas) | Chronic | Months to years | Dull aching | Variable | - | +/- | +/- | - | - | - | - | - | - | - | - | - | - | Tests used to rule out other pathologies;
CBC
ESR
LFT
Urine analysis
|
Radiography
CT
MRI
PET - FDG
|
||
Leukemia[107][108][109][110] | Acute or chronic | Weeks to years | Aching | Variable | - | +/- | +/- | - | - | - | + | - | - | - | - | - | - | CBC
Coagulation study
Peripheral blood smear
Blood chemistry profile
Blood culture
|
|
| |
Lymphoma[111][112][113][114] | Chronic | Months to years | Aching | Variable | - | +/- | +/- | - | - | - | + | - | - | - | - | - | - | Typically no specific lab findings, however, the following routine tests are performed;
|
Radiography
CT
Bone scan
Gallium scan
MRI
PET - FDG
Ultrasound
|
| |
Multiple myeloma[115][116] | Chronic | Years | Dull aching | Hips, groin and legs | +/- | +/- | +/- | - | - | - | +/- | - | - | - | - | +/- | - | Serum protein electrophoresis
Serum free light chain assay and 24 - hour urine collection
CRP
Serum beta2-microglobulin
Albumin
LDH
Peripheral blood smear
|
Radiography, MRI and PET
|
| |
Neurofibroma[117] | Chronic[118][119] | Weeks to years | Aching, pressure | Variable | - | - | - | - | - | - | - | - | - | - | - | - | - | Molecular sequencing
Urine analysis
|
Radiography
MRI and CT
PET - FDG
|
| |
Osteoblastoma[120][121][122] | Chronic | Weeks to years | Dul aching | Variable | - | - | - | - | - | - | - | - | - | - | - | - | - |
|
Radiography
CT and MRI
Bone scan
Angiography
|
| |
Osteoid osteoma[123][124][120] | Chronic | Years | Dull aching | Variable | - | - | - | - | - | - | - | - | - | - | - | - | - | Serum chemistry study
|
Radiography
CT
MRI
Radionuclide scan
Arteriography
|
| |
Osteosarcoma[125][126][127][128] | Chronic | Weeks to years | Severe, sharp | Variable | - | - | - | - | - | - | - | - | - | - | - | - | - |
|
Radiography
CT
MRI
Bone scan
|
| |
Prostate cancer[129][130] | Chronic | Months to years | Severe, sharp | Lower abdomen, hips, groin and legs | - | +/- | +/- | - | - | - | +/- | - | - | - | - | +/- | - | PSA
Acid and alkaline phosphatase
Serurm creatinine and LFT
Urine analysis
|
Ultrasound
MRI
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Muscle-related | Abnormal posturing[131][132][133][134] | Chronic | Years | Dull aching | Shoulders, arms, hips, legs | +/- | - | - | - | - | - | - | - | - | - | - | - | - |
|
|
|
Muscle spasm[135][136] | Acute | Days, weeks, months | Aching | Variable | - | - | - | - | - | - | - | - | - | - | - | - | - |
|
MRI and ultrasound
|
| |
Pyriformis syndrome[137][138] | Chronic | Years | Aching | Hips and legs | +/- | - | - | - | - | - | - | - | - | - | - | - | - |
|
MRI and ultrasound
|
| |
Classification of pain in the back based on etiology | Diease | Clinical Manifestation | Diagnosis | Comments | |||||||||||||||||
Symptoms | Signs | Lab findings | Imaging | ||||||||||||||||||
Onset | Duration | Quality of pain | Radiation | Stiffness | Fever | Rigors and chills | Headache | Nausea and vomiting | Syncopy | Weight loss | Motor weakness | Sensory deficit | Pulse Deficit | Heart Murmur | Bowel or bladder dysfunction | Horner's syndrome | |||||
Miscellaneous | Chronic fatigue syndrome[139][140][141] | Chronic | Years | Dull aching | Variable | +/- | - | - | +/- | +/- | - | - | - | - | - | - | - | - |
CBC
LFT
TFT
ESR
Serum electrolytes
Serum protein electrophoresis
|
CT and MRI
PET
|
|
Depression[142][143][143] | Chronic | Months to years | Severe to mild aching | Variable | +/- | - | - | +/- | +/- | +/- | +/- | - | - | - | - | - | - |
|
CT and MRI
PET
SPECT
|
| |
Dysmenorrhea[144][145] | Acute | 3 - 7 days | Burning, dull aching or severe | Groin, hips, legs | - | - | - | +/- | +/- | - | - | - | - | - | - | - | - |
|
Ultrasound
Hysterosalpingography
IVP
CT
MRI
|
| |
Herpes zoster[146][147][148] | Acute or chronic | Variable | Severe, stabbing, electric-like | Dermatomal | - | +/- | +/- | +/- | +/- | +/- | +/- | - | +/- | - | - | - | - | Tzanck smear
Direct fluorescent antibody test and/or PCR
|
MRI
Lumbar puncture and cerebrospinal fluid analysis
|
||
Pregnancy[149][150][151][152][153] | Chronic | Pregnancy term | Dull aching | Groin, hips, legs | +/- | - | - | - | - | - | - | - | - | - | - | - | - | Beta - human chorionic gonadotropin
|
|
||
Sickle cell anemia[154][155][156] | Acute or chronic | Variable | Severe, sharp | Variable | +/- | + | +/- | - | - | - | - | - | - | - | - | - | - | CBC
ESR
Reticulocyte count
Peripheral blood smear
Hemoglobin solubility
Hemoglobin F
LFT, renal function test and pulmonary function test
ABG
Urine analysis
Sickling test
Secretory phospholipase A2
|
Radiography
MRI and CT
Nuclear imaging
Transcranial doppler ultrasonography
Abdominal ultrasound
Echocardiography
|
| |
Syringomyelia[157][158][159] | Chronic | Years | Dull aching | Variable | +/- | +/- | - | +/- | +/- | - | - | - | - | - | - | - | - | *Typically no specific lab findings | MRI
Radiography and CT
Gadolinium scan
Myelography
|
||
Trauma[160] | Acute or chronic | Variable | Severe, sharp to dull aching | Variable | +/- | - | - | - | +/- | +/- | - | +/- | +/- | - | - | +/- | +/- | After establishment of first aid protocol, the following lab tests may be useful;
Pregnancy test
Blood typing, screening and cross matching
Prothrombin time
Creatine kinase
Blood sugar
Cardiac enzymes
Toxicology screen and alcohol level
Serum lactate
|
To assess trauma, the following imaging may be used;
|
||
Ureteropelvic junction obstruction (UPJ)[161][162][163] | Acute | Hours to days | Dull aching | Groin, hips, legs | - | +/- | +/- | +/- | +/- | - | - | - | - | - | - | +/- | - | CBC
Coagulation profile
Electrolyte levels
BUN and serum creatinine
Urine culture
|
Voiding cystourethrography
Renal ultrasonography
IVP
CT and MRU
Doppler
MRA
|
|
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